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425-252-1666 CM HEATING 01:36:03 p.m, 05-13-2015 <br />ELECTF�AL pERMIT APPL�C <br />ATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wq gg201 <br />425-257-8810 - FAX 425-257=8857 —www,everettwa.vrg <br />.3 La VI'� ,�y101^-e <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Contractar� <br />� <br />Mail Address <br />Mail Address <br />rcr,� <br />Mail AddreSs <br />1�1 g�7 D� <br />State License Nurrtber (required) <br />Proposed Lise of Building <br />� �/{�� <br />City <br />City <br />Square Footage (If resldential new construction, remodel or addifion) <br />Number of devices (If low voltage) <br />Description of Work to 8e Done: <br />City <br />v�� <br />� �25 7 z ��� <br />Stat ip Phone <br />State2ip Phane <br />�z� 2�9 c���� <br />State/Zlp phone <br />Dl(o04R <br />Ctty of Everelf Business Lfcense Nurnbet (required) <br />a5� -� <br />Contract Price oF Work <br />• ��?ti� `—" � ����l�t/ <br />Co act Person/Contact NumbedEmail <br />C1TY OF EVERETT LOCAL SALES TAX CODE 15 3105 <br />I hereby ce�fify that l have read and ezamined this application and know the same fo be true and <br />corrsct. Al/ piavisions oflaws and ordinances goveming fhis type of work will be comp/eted <br />whetherspecified herein ornot. The granting ofa perrnit does notpresume to give authorify fo <br />violate or cancel the provisions of any ofherstate orlocal law regulating construction orthe <br />performance of construction. .That l am authorized by the ownerofthis pmperty to perfoirn the <br />wor/t for wh. ich app/icafion Is made and / comply with fhe Stafe. Contraclors Law 16.27 RCW and <br />296.200 WAC. <br />, <br />Sionafurcx - �•/� •�� <br />REVI SED OB,flC,�2p� q <br />FEE <br />� � 6L <br />PERMIT# <br />E I 5 C�� - �CvS <br />3 /3 <br />