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425-252-1666 c.m.heating 08:13:55 10-02-2015 6/6 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> ��Slo --ogL7 <br /> 11).4 --15 <br /> 3 1S-c-� 3a 1 Se agate <br /> PROJECT ADDRESS <br /> Gf\ L n Caeoacp---sza+na c233a ks-c t c-e cuce r LA qhs 25 315448 <br /> Owner ail Address City State/Zip Phone <br /> Tenant Mall Address City State/Zip Phone <br /> Cii\ A G lPhU c e• LoA GSA\ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> ra(3 r3n sOg5 gs61-o0/ <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact umber/Email <br /> 0h . <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: li 'Q(i. 1(S <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> Oc <br /> 1 hereby certify that I have read and examined this application and know the same to be true and 45G, <br /> correct. All provisions of laws and ordinancesovernin <br /> g g this type of work will be completed <br /> Yp p ed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E 15 \ 0-0(41 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and v <br /> 296.200 WAC. <br /> klb&e <br /> Signature Dale <br /> REVISED 08/0612014 <br />