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425-252-1666 CM HEATING <br />23a.m. 03-02-2015 3/3 <br />ELECTRICAL PERMIT APPL�CATION <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 />�{a3�� �`iLr��1� �l11�. <br />PROJEC7 ADDRESS <br />C�1.�� i h L <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />Electrical Contractor' Mail Address <br />m g-r7b� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be pone: <br />CITY OF EVERETi' LOCAL SALES TAX CODE 15 3105 <br />'a S 37� 8�0 <br />Cily <br />C(ty <br />City <br />State/Zip <br />5tate/Zip <br />0� Z� <br />StatelZip <br />Phone <br />Phone <br />25q t�l�(�(� <br />Phone <br />- o � (v�R <br />City of Everett Business iicense Number (required) <br />too ' <br />Contract Price of Work <br />S��l� "� U� '1�1�'tQf�,u'IP�i. Gt�'ir�C.� <br />Contact Person/Contact Number/Emai <br />I hereby certify thaf I have read and examined this application and know the same fo be true and <br />correct. All provisions of /aws and ordinances goveming this type of work will be comp/eted <br />whether specified herein ornot. The granting of a permit does not presume to give authority to <br />violale or cancel the provrsions of any otherstate or/ocal law rEgulating constructron orthe <br />performance of consiruction. That / am authorized by fhe owner of this p�perty to perform the <br />work for which application is made and I comply wifh fhe State Contractors Law 18.27 RCW and <br />296,20a WAC. <br />REVISED 0(L4fi20f4 <br />1" 1 �CJ � <br />FEE <br />��� <br />,f � <br />PERMTT# <br />E � � �,� -� �v <br />