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-425-252-1666 CM HEATING 1r 74.18 a.m. 07-28-2015 2/4 <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 /> 93 le' Dr SE <br /> PROJECT ADDRESS <br /> LarsU s Oi la rtiu (Ylaa rt e r aiJ 3 I D Dr S E Everitt IMI q -Z o� 4.S 4123-5504 <br /> Owner J Mall Address City y State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> an 1Iea inq I n(— 1815 Oroadik90.9 ester , WP Mot 4_252s3 [Dlolalo <br /> Electrical Contractor Mall Address City State/Zip Phone <br /> 6mv-g-i71)KI oI (ooag <br /> State License Number(required) City of Everett Business License Number(required) <br /> 4 )DI 891-1,150 <br /> Proposed Use of Building Contract Price of Work <br /> Debbie, R wirsiL125 25`10554/ d ebb;e e <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact umber/Email cynkpedltJ,u1 <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: I n5r QI 1 dI k-i n hoaf rump 9s-t:ef r\ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 41 tr"J' r ,00 <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <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 i '5 61 -- 1 t61 <br /> work for which application Is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> x'2'7.15 <br /> Signature (S <br /> Dale <br /> REVISED 0&476/2014 <br />