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425-252-1666 c.m.heating <br />_ _ _. _. . . ._ _ _ . . . _ _ � <br />08:13:04 10-02-2015 2/6 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMtT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9B201 <br />425-257-8810 - FAX �425-257-8857 — www.everettwa.org <br />, � ��r • <br />�l1'� � L� ��! • _ � <br />-. •..- <br />��c� 1�J�1,�\�S i,� 1 F'� ��L �'t �-e�� ��� 3�o—�'-f6—b�S� <br />Owner Mall Address CIty State/Zip Phone <br />Tenant <br />Mall Address <br />Electrical Contractor LJ Mai1 Address <br />��eArn�, g-n� <br />State License Number (raquired) <br />Proposed Use of Building <br />5quare Footage (If residential new construct(on, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />��1 <br />State2ip <br />Phone <br />� �s ��c�a <br />S1ate2lp Phane <br />�i��gg <br />City of Everett Business Licensa Number (required) <br />��� <br />Contract Price of Work <br />�i�teL3�v.�S /��5 �-oS�/ <br />Contact Person/Contact NumbedEmail <br />"���3��c,c�t�h� . cam <br />I hereby cQrfify that I have read and examined this application and know the same to be true and <br />correct. AIl provisions of laws and ordinances goveming this type of work will be completed <br />whether speci�ed herein or not. The granting of a permit does not presume to give authority to <br />violafe or cance/ ihe provisions of any other state or loca/ law regulating construction or fhe <br />performance of consfruction. That l am authorized by the owner of this property to perforrn the <br />wark for which appllcation is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />g 3o/f� <br />REVISED 0&D620f4 <br />FEE <br />.� � �,. DC� <br />PERMiT# <br />E I 5 I�� f�C�� <br />.......... . .......... .__.... .._....... _... .... .._._, ........... ..._._........ ..._._... ......... _...... ......., ._.._. ........ . . ._ ._ .._.___. <br />. ._ ... ................ ........ _..__ ........ <br />