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�LECTRICAL PERMIT A�LICATION ' <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(�°) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa,gov � www.everettwa.gov/permits <br />�_ __ CONTACT INFORMATION . <br />NAME- <br />MAILING ADDRESS: s��T <br />crrv <br />PHONE: <br />�CTOR NAM E: � (M l � /I � <br />TENANT NAME <br />OWNER EMAIL: <br />ADDRESS: srnJeEr I�'l �� I L�'ii fCV-(' �\T <br />STAiE Z�p <br />�11�ii��� _ �1 . / <br />EMAIL: <br />� <br />CONTRACTOR LIC. #(REQUIRED : U �S SL—��� I QS CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �� 4 ��j � <br />�� �t h � � V 1 ��C� � r CONTACT EMAIL: 7C •l VC�, I�I � , �l ✓� < L S . �_ p � <br />AGREEMENT.• T hereby certify that / have read and examined this application and know the same to be true and conrect. Ap provls�ons of /aws and ordin ces goveming this <br />type of work will be completed whether specified herein w not. The grantirtg of a permit does not presume to g'rve authaity to vio/ate or cance/ the provisions of any other state or <br />local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perfomt the work for which application is made and l <br />comply with the State Confractors Law 18.27 RCW and 296.200 WAC. <br />City of Everett O�cial Use On/y <br />FEE • <br />�O � � � <br />PERMIT # <br />� E ���� r 2.� �� <br />(Revised 10/12/2015) <br />� ��c�o� � 02��1 <br />