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425-252-1666 C M HEATIN G 10:33:10 a.m. 08-31-2015 2/4 <br />__.. -- --.. _ ..__ . ._ ..__ _ --- .....- .. .. _ ._ ..._. _ . _ ... .... ._.. . _ ...... . .. ........ .. . <br />__ .. ._ _..__ _.....,..._ ..... ---.. .._ .... .... ..._.. _... _ _. _.._. <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT', WA 9820� <br />425-257-8810 - FAX 425-257-8857 — www.evetettwa.org <br />� � �' V�I�,.i'�'IUY� �iVQ� q$20 j <br />PROJECT ADDRESS <br />2oco— 5�s�s� <br />SuSa.� T��►�c.� 3�1) � v�l Q.�hm��L 14�e, E�ere� W K� q 8 Zo 1 5� <br />Owner Mail Address City State/Zlp Phone <br />Tenant <br />Mail Address <br />Electrical Contractor ) Mail Address <br />�'.m�tE�m�+g��-�N <br />State Li�ense Number (required) <br />Praposed Use of Building <br />City <br />City <br />State/Zip Phone <br />$20 � yZ5 25q � <br />Stale/Zip Phone <br />�1t�09F� <br />City of Everett Business License Number (required) <br />��'�iA eZ� � <br />Contract Price of Work <br />Debbi� 8�a.uc�s1y2�25�• os5o� <br />Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br />I dQbbi�c @�n'►hea�i • <br />Number of devices (If low voltage} <br />Description of Work to Be Done: y��� Dlj��'�,Q�j�j fiQL�,�' (�� Su�j"1•Q,i1� <br />CI'fY OF EVERETT LOCAL SALES TAX CODE IS 3'!05 <br />l hereby certify that l have read and examined this application and know the same to be true and <br />correct.' All pr�visions oflaws and orrlinances governing this type of work will be completed <br />whether specifred herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or /oca/ law regulating construciion or fha <br />performance of construction. Thaf I am authorized by the owner of fhis property fo perform the <br />work for which application is made and l comp/y with fhe State Contractors Law 18.27 RCW and <br />296.200�(VfJ C. <br />-i� <br />Rewseo on�r�oia <br />FEE u <br />,��00, <br />. <br />PERMIT# <br />El �r1o� <br />� <br />Gor <br />