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Zl y /8S <br /> - - _--�--- -- - ---�------- <br /> ELECTRICAL PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> ?200 CED�R STREET, EVEREIT, WA 98201 ,` ��.7 <br /> 425-257-8810 • FAX 425-257-8857 —www everettwa.org (T�y�� <br /> / a —�-/� <br /> 30C3 West Casino Road <br /> PROJECT ADDRESS <br /> IThe Boeinc� C�Tpany P .O. Hor. 3707 Scattle, Wa 9t3.24 <br /> Ovmer Ma�i ACdress Gry Slatc2o P^onc <br /> I <br /> 7Pnent FAa�lA0tlres5 Ciry SlaleZp Phonc <br /> Prime filectric 133Ui SE 2Gth St Bellewe, Wa 98005 425-747-5200 <br /> ['ledrical Conlractor Ma�l Adaress Cny Stale�L�p Pnone <br /> NRIMIiF•.I134HT 01994G <br /> Stnte iicense Numbe!(requir:A) City ol Fveretl �usiness Licer.se Numbe�(reQwred� <br /> $6, 882.00 <br /> Proposed Use ol t3udd ng Con�rdd Pricr. of Wo�1c <br /> Tom O'Hara <br /> Cohara�aprimcclectric.com <br /> SQaare Fuolagv(il resitlenlial new wnxlruct�on, rer^�odel or addnion� Conla[t Person/Co��acl NumbedE�r.ad I <br /> Numbei al devices(If iow voB:�yc) <br /> DescnpuonulWorktoBeDone� Znotall 20A 120V receptacle in vault foi aump pump 6 <br /> connect 15A 208V eplit AC unit in tho phaxmacy Bldv_ 40-921 <br /> f[E �CITY Of EVERE7T LOCAI SALES TAX CODE IS 7105 � �� 5S <br /> I IrereGy cerfity fhet 1 have read nnd examined thrs epP�icahon and hnow Ihe samc tu bc hue anJ ___ __ J <br /> r.onecf All provit�ons r.11aws and ortf�n�nces 9ovaniny fh�s rype ol woM will be completed ---- -- � <br /> whethei spr.ciheA hcreui or nof Tho yrun6n��l a pemut does nof pmsumc(o grve authonty fo PERMCT# <br /> vrolnlo ui cnncYd fhr,provrsions al any oUmr sfufe or ior.ol law rvgW�lrng consfnichon or tAe � �"/ <br /> peAomiance ol consfruGwn lhef;nm aufhonleAAy fhe ownei n!flus propnRy fn peAovn Ihe j�� � 0� -f� <br /> N�oAc lor wlrich�pplice0on is made ond I comply wilh the Sfote Confractors Law 18 2i RCW and � <br /> 796.200 WlIC <br /> �.� '�<��� "�4 �_1 B/� I <br /> Signature I Date � <br /> �F1v5EOCR4r✓.`0�� <br />