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d25-252-1666 CM HEATING � 26:31 am. 04-17-2015 3�4 <br /> ELECTRI�AL PERMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425•257-8857—vwvw,everettwa.org <br /> 2! Z5 farcw�d Atl� <br /> PROJECTADDRESS <br /> 1�,a,v'Q.r� (�der�an sam.e, a.t�o✓e y Z5 z�b ��}I �' <br /> Owner h7ail Address Clly Sl�le2lp Phone <br /> TOnO�I h7a11 Add�ess Cily S�aleZp Phonc <br /> ea ' c. ._1�15_�Yc�du�ria.t Eit��tt� WR q8a.ol .�26 2�9 t��t�� <br /> ElacUical Conlractof� � ldaii qddross �_ � City StatelZlp Phono <br /> Cm►�t+g�� �� oi t�oqR <br /> Stale Llcerise Number(required) City of EVcreICBUsiness Llconsa Num6er(required) <br /> 25b '-' <br /> Proposed Uso af Bulldin8 Conlract Pdco af Wo�C <br /> I�l'J�JI�L� <br /> Square Foolage(I!residential new construcllon,ramodel or eddltion) Conlact erson/Conlacl Numher/Email <br /> Number of devices(If low vollage) <br /> DescripUon oI Work to Be Done: �'���['�'�jJ�,S t.lp�j — p��� <br /> FEE <br /> CITY OF EVFRC•TT LOCAL SALES TAX CODE IS �105 � � �b <br /> JV� J <br /> 1 horsby certily fhaf I havo rond anJ oxamined lhls eppllcafion and knoly Uin snme fo 6o fruo and <br /> correcf. All provlsfons ollaws and ordlnancos govoming Ihls fype ol worfc wlll 6o comploled <br /> whefherspoclfiod heroln ornot. Tho gran(ing aIa permlt daos nof prosumo fo glva aulhori(y to pERMIT# <br /> vfolafo orcancol fho provislons ol any alhorstato orfocel�nw rngulaling constiucfion orlhe 1 �O� � �� <br /> pedormdnce ol cons(rucffan. Jimt I am oufhorteed by Iho ownor of thls properiy(o podorm�ho � � � <br /> work lor whlch nppllcaBon Is mado ond 1 comply with fho Sfele Corifracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � �•ll•f5 <br /> Slgnalurn Oate <br /> r�nsm csaeao�� <br />