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ELECTRICAL P�ERM��' APPL�CATION
<br /> CITY OF EVEREI'T PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everethnra.gov� www.everettwa.gav/permits
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<br /> ��tLDING.AREA i�resldential,r�ew construction,remodel,or�dditi�r�°
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<br /> BWIDING TYPE: ❑ SFR-QETACHED ❑SFR-A7TACH�p ❑DUPLEX ❑MUL71-FAMILY-#OF UNtTS;; ❑ COMMERCIAL
<br /> USE OF BUILDINQ: _ _,, . _ , _ __
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<br /> CONTRACT PRICE.;QF WORK: $ � ,a'
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<br /> fik�S�PCIATED BU,II_D.lN,G PERMIT# if a", �icable i
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<br /> 0111fMER NAME: ,_ , `_ _
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<br /> OWNER MAILING ADDRESS: srREer 2 �-. ;'�',�'' : r , � _
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<br /> OWNER PHONE: v�D(p e{.: < �°�� OWNER EMAIL:
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<br /> C;�NTRACTOR NAMEi
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<br /> CONTRACTORADDR�SS: srn�er � ; .: �(�� ;:
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<br /> �'RIMARY CONTACT: ❑OWNER CONTRACTOR �OTHER{Please 5pecify) �
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<br /> AGP.�E/s!'�:;���,���;that:have read and examined(his epplicetfon end know fhe same to be lrue nd conect A!f provls�tews an�� ::
<br /> °��"�����t�d ivl�ther apecl�ed he�ein or nof. The graMing o/a permll does not presume to glve eu(hwlly to vlolats or cance(the provtsfont s of any other sta ehortyFe
<br /> Iocallaw regulat(ng constrvcffon or lhe pedormance o1 conshuction. Thaf i am au�hodzed by 1ha owner of this property lo perform the wotk lar which appticaUon is made and t
<br /> comply wl�h fhe 5tale Confracfors Law 18.27 RC W and 296.200 WAC.
<br /> Qlly of Evsrett OH/clai Use Only
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<br /> Qwt�vrly0.ut�tor�t+er��gent t�.�natu�a -
<br /> � . Date
<br /> (Revlsed 8/23/201$) � "` `
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