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LLECTRICAL PERMIT AP LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 9B201
<br /> (P)425-257-8810 � FAX 425-257-8857 ( (E)everetteps@everetfwa.gov� www.everettwa.govJpermits
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<br /> PROJECT ADQRESS. ' '��j : - :
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<br /> BUILDING.AREA,{��1�g����j���new constructlon,remodel,or�tfc�l���tj ��,
<br /> �l�6E..�ING TYPE SFR-DETACHED �SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMf LY-#OF UN�1`��
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<br /> CONTRACT PR10E OF WORK $ `
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<br /> NUMBER OF DEVICES i�low-t��t� e;, :_ `
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<br /> ;QWNER NAME: ' , , ..
<br /> , ' TENANT NAME 1'�in�r��+��i� ; _
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<br /> ���.�R MAILING AQDRESS: srReer `
<br /> _ CITY > _ STATE V V.�
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<br /> OWNERPHONE: _ _ .
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<br /> Gf�i�TftACTQR NAMEi. � , , . . � : .
<br /> C.1��"f'�1�'�'��ADDRESS: s1R�Er � __
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<br /> PRlMARY CONTACT: ❑OWNER 'CONTRACTOR �OTHER(Pfease Specify)
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<br /> �NTACT NAME: `_
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<br /> � �,���w��� CQNTACT EMAtL
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<br /> AGREEMENT I here6y ceNlfy thaf t have reed and exem/ned fhls app/lcatlon and know lhe same to be Uue end conecf. Aliproyslons o/faws and oldfnancea goveming this fype
<br /> ol walc wili be comp/efed whefher speclfled hereln or not The grsn(tng of a pertnf[doss nof presume to g/ve aufhority fo vlo/ate orcancef lhe provlslons of any other s�ate or
<br /> local law regula�ing conshucUon or the perlortnance o/construcfion. That!am aufhorized by the owner of Ihls propetty fo perform�(he work(or wh►ch applicatlon!s made snd f
<br /> comply wlth the State Contracfors Law 18.27 RCW and 296.200 WAC.
<br /> Clty ofEvsreft 0/i1clst Use Only
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<br /> �+�Ct'�n't�i�rth�it'la�d Agent Signature '� O
<br /> Date ,.
<br /> (Rev(sed 9/23/2016J ',
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