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08/17/2016 wEo 15:27 FAx 425 252 1666 CM Heating �003/ODa <br />�CTRICAL PERMIT AP�ICATIO.N <br />CITY OF EVERETi' PERMIT SERVICES <br />320d CEDAR STRE�T, �V�RETT, WA 96201 <br />(P} 425-257-8810 � FAX 425-257-8857 �(�) everetteps�everettwa.gov � www.everettwa,gov/permits <br />;�:, 1,..n. . . d. Y t a � <br />� � ) 4 � � '� i, . , <br />1�..n•i6.i( 4S.Ji�a7r Jtt,���l�,i,; .i'1�., ��n� ii„l�.r�3����'��,�� �� � � r � � ,. ' <br />- .—. . .,i . , . ,,. _ , , , , ''7' , . . �� . <br />ER NAM�: c il�� i� <br />�R MAILING ADDRESB; <br />ER PHoNE: <br />CONTRACTO�t NAME: <br />CONTRACTOR ADDF2E <br />BTREET <br />C�Y <br />c iTv <br />_ _ '��NAfYT NAM�SIf Cotllmaral <br />� ,.2 � <br />� _ BTATE <br />OWN�R EMAI�: ' <br />� �J�II -. <br />� 8TA7� <br />ZIP <br />LIP <br />CQNTRACT4R PHONE; bZ v��d CONTFtACTOR EMAIL; � -�����j � <br />CONTRACTOR LIC. # REOUIR�D i Ii1 pITY pF �VBR�YT BU81N�88 �IG, #(REOUIRED • � <br />PRIMARY CONTACT: ❑ OWN�R CONTRACTOR ❑ QTH�R (Please SpecNy) <br />CONTACT NAME: � CONTACT PHON�; � <br />�� O -� <br />CONTACT EMAIL: � � � ��. <br />AORFEMENT.• T hareby Certl(y that I hava rgad and examined fhl9 epplloaffon and know �he 9eme ta be trua and oorreot. AI! provrafons of laws �hd ord naas goveming thls <br />fypa oI work wll! bs complefeA whethar syeclOed haraln or nof. Tho flrenllnQ Of e pormlf do�a no! prasum@ to give eufhorlfy to vlolefe or cence/ l�e provls/ons of eity other s�ate ❑� <br />locel /aw regulgfing� caflafructlon or fh9 performenoo o/ aon��ruCllon. 7'het f em �u1H0�1r9d by the owner of fhla properfy fo pgrforrrt fhe work lor whlch applloeflpn Is made and 1 <br />c�mply w(!h fha Sfele Co�lrgCfas Lew ?8, 27 RGW and 294.200 WAC. <br />l� <br />Clfy of Evergft O(flcfA! Uea Only <br />FEE <br />.�� , � �� <br />PERMIT # <br />� � '°L�'�-i � '� � �j �� <br />(Revlsed 10/12/2015J <br />