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<br /> ' .;�, �L�CTRICAL P�I�M1T ApPLICAI"ION
<br /> �� C17Y�F EV�RE'f'i'pERM1T S�RVICLS
<br /> " 320�C�DAR STRE�T, �VERET'T, WA 98201
<br /> (P}425-257-$�1 p � FAX 425�257-8857 � (E) everetteps�everettwa_gav f www.everettwa.gov/permits
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<br /> BUILI]tNG TYP�: ❑SFR-Ar�TACHED C7 SFR-ATTACH�A �) DUPLEX ❑M�1LTi-FAMU.Y-#OF UNITS: 0 COMMEFtCIAL
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<br /> CONTRAC7'�'RlCE OF WORK: $ 6Q r
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<br /> OWNER NANI�: TENANT NAME lf Cornmerclal):
<br /> QWN�R MAlI�ING AppR�S�: srneer � f�Z �'
<br /> �'� �� SYA7E I/V�" Z1P ��
<br /> OWNER PHaN�: ��.5 ��D�, OWN�R�MAI�:
<br /> CONTRAC3'OR NAME: �� i
<br /> CONTRACTOR ADDRESS: ;�: STREET I� � Q� �
<br /> �fi`•.' c��rc S7wTE ziP ��
<br /> CONTRACTOR PHOWE: p+� �' C�NTRACTOR�MAI�:
<br /> CONTRACTOR L.IC.#(R�RUI�t�p): I�.I.�I� Z� CITY OF 6V�R�73'BUSIN�SS LlC.#REClUIftED:G'J
<br /> PRIMARY CONTACT: C]Q�VNNER L�CONTRACTOR .�OTHER(Please Speclfy) b�I A f T
<br /> C�NTACT NAM�; �t • CONTACT PI10NE: �' � ��,
<br /> C.p�( L,/L� :;r � CON7AC7 EMAIL:
<br /> AGRE�'M�fYT 7 hereby cenify that�l have iaad and examined fhls spplleatlan and xnow ree same to De true antl commct AI!prov�s;ens oflaws aea orUlr�ances go,reming th;s
<br /> tyPe af wo�k wi!!de aompleted whaF(7ar apecified harein ar nof. Tha granting of a permit does nof preeume to ghre autnorlry to vJolate or cance!tAe provlslons of any o[Aer state or �
<br /> lxaf!ewlEgv/8ting GORSt�vGtron o1 t�lB pBtlomteete ofCOnsthiGGOn. 77faf/&m authoraed bythe owner of this prapeny to perfam7 the work for which aAR<«ation is made and l
<br /> �arrtply wlth the State Coni�actors(,;�w 78,27 RCW anp 29b,200 WkC. . ,
<br /> ;r�. City of EveretlO�Cia1 USB Onl y
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<br /> � erl ttiori�atl Agent Slgna;F�re ete (Revlsed i0/1?J201S)
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