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425-252-1666 c.m.heating 12:33:46 11-24-2015 1/2 <br />___ . _ _ _ __ • <br />_ . _ <br />ELECTRICAL PERMIT APPLtCAT10N <br />CITY OF EVERETT PERMIT SERV[CES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAJC 425-257-8857 — v���+�,,v.everettwa.org <br />�o� �I �-e S�' <br />,OJECT ADDRESS <br />��i� �6�c�P.� ��a pINQ- ST P��...(.� �,��- �'� ! �-�3°I-�� <br />n�f F.lail Addras� Ciry Stal�/Zip Phana <br />iant <br />:trica( Contractor <br />P�iail Address <br />Filail Addrass <br />.�m�M �+g�7 �� <br />a Licanse Number (required) <br />�os2d Use of Buil <br />ara Footsge (If residential ne�rr construction, remodel or addition) <br />� <br />nber oF devices (If low voltag <br />cription of Wark to Be Done: ��_ i���� � <br />City <br />Cltq <br />Slate2ip <br />p� g �,o I z� <br />StatalZip <br />Phane <br />2�9 ���� <br />Phone <br />�� [IJ��� <br />City af Everett Business License Mumber (requiredj <br />�a�_� <br />Cantract nce of Work <br />I�e,�ec� ` -r "fas as�� � � � <br />� r i �� <br />Contact Person/Contact �lumbzrlEm <br />FEE <br />Y OF EVERE7T LOCAL SALES 7AX CODE IS 31 �5 � I�•�� <br />l <br />reby cerfify that I have read and examined this application and kno�v ths same to be true and <br />-ect. All provisions of la�vs and ordinances goveming this fype of �vork �vil1 be completed <br />�fher specified herein ornot. 7he grarating of a pertnit does n�t presume io give aufhority to PERMIT� <br />ste or cancel the provisions of any othe� state ar lacal !aw regulating construcfion or the r�� � <br />°ormance o( construction. That 1 am aufhorized by lhe awner of this property to parform fhe C l I-� c'�p <br />ic {or whlch applicafion is made and 1 comply with the 5iate Contractors Law 1B.27 RCW and <br />l 200 WAC. <br />i��o�;ire, c I � ��y � � � <br />Sionature <br />s�D asca,z>>� <br />_ _ . . .._.. . _ <br />� <br />