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ELECTR�'CAL P�R�IT APPL�CAT�;ON
<br /> CITY OF EVERETT PERMiT SERVICES
<br /> ; 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetlwa.gov( www.everettwa.govlpermits
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<br /> P�t}<I��`�.ADDRES5<; ���� � ;� "
<br /> ��11LDIIVG AREA(if residentlal,hew cc�nsfru�tiq�a,remodel,or��id�t�n°. ._ �F .
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<br /> BUILDtNG TYPE:
<br /> SFR-DETACHED ❑SFR-ATTACHED C1 pUPLEX ❑MULTI FAMILY-#OF UNITS 0 COMMERCIAL
<br /> USE OF BUILDING:'� _
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<br /> �#�NTRACT PRICE OF WORK: $ , (a ,°'O
<br /> NUMBER OF DEVICES _�1ow�.ff e: . :. .__. _
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<br /> ASSOCIA'TED BUILDING PERMIT# 4t� 1t�tile ;
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<br /> > �'T(���"'�f�;�'R�t�u��#�j�; ��"4 °. CITY OF,EVER�7T�USINESS LIC, , i�tJl�Gr. , ' ` �
<br /> PRtMARY CONTACT: ❑OWNER CON �� ��� ," � _ w r .. . _� .. . : _ .�._ �_.� � ..,
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<br /> TRACTOR ❑OTHER(Please Specify}
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<br /> CONTACT NAME: �t3�`ACT PHONE: ` ��� � ,
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<br /> AGREEMENT,-:1 hereby ceriJ/y fhaf 'have sead and examined this applicetton and know lhe same to be bue end conect. Allprovis�ons of iswa and ordlnences govem/ng fhis lype
<br /> af work wiN be crompleted whether speclted hereln or not The granftng of a permll does nof presume to ghre aufha�ry�o vloiate or cansel the provlsMns af any ofher state or
<br /> locat law�egulating cons�rucflon or lhe petformance o1 consfructlon. Thad,�em auGtortzed 6y fhe awner of Ihls propeKy fo perform the work ior whlch applkatfon Is made and�
<br /> comply wifh the 8tate Confractors Law f 8.27 RCW end 296.200 WAC.
<br /> Clty o!Evsrelt Ofl`7clai t/se Only
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<br /> Own+�.�IK�ht�€t�i�'�Agent SEgMatu'we. � � �;. .; .::....,..� ' : ��.
<br /> Da(e (Revised 9/23/2016) ._
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