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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.gov <br /> 1800-41st St., Everett, WA 98203 <br /> PROJECT ADDRESS <br /> The Everett Clinic- 1800-41st St, Everett, WA 98203 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> D. K Systems, Inc. -PO Box 886, Burlington, WA 98233-360-755-1555 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> DKSYSI*987M6 049744 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Medical Administration Bldgf O O <br /> Proposed Use of Building Contract Price of Work <br /> Kevin Korthuis-360-770-7981 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> kevin@dksystemsinc.com <br /> HVAC System JV 171Qj <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: HVAC Systems /A _ ! ,1 ev . sToS f (tflt) V b <br /> \i-Zkoe) <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 4 r„O ®c <br /> I hereby certify that I have read and examined this application and know the same to be true and V J <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 S\ 1 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and I <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />