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• Z� i���1 Z <br /> ELE�TRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857-www everettwa.org <br /> �,�s-/ S <br /> �-i5p6-t�-3'� ' <br /> �zs ao�rt i �t <br /> . PROJECT ADDRESS <br /> I <br /> � )AMI.S ][AGGLUND �?5 aO�rH P� EVEItETT �vA, 93201 425-876-7507 <br /> �, Ovmer MailAddress Ciry Slale2ip P�one <br /> Tenant Ma�l nddress Ciry Slaie2�p anone <br /> 11M COt�IFORT SYSTEMS 18103 NE 68TH ST, C-200 RED�IOND WA/9A052 425-SS1J920 <br /> Elednral Contractor M11ai1 Address Cny Stale2ip Pnone <br /> p1�iCO�IMC92JC$ 5450 <br /> State L�cense Nurnber Contract Pnce of Work <br /> JANET CHELGREN <br /> SINGLE FADIII.Y _ <br /> Proposed Use of Budding Contact Person (Plan Rewew) <br /> Square Footage p(residential new construction, remodel or addilion) <br /> Number of devices(If low valtage) <br /> Descnption of Work to Be Done: <br /> RL•PLACE GAS FURNACE WITH NEW, LIKE fOR LIKIi AND INSTALL NEW HIiA'I' PUMP <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 r J��/'"., <br /> v��/ <br /> 1 hemby cerfdy fhaf 1 have mad and ezamined(his application ond know Ihe same lo be true and <br /> conecL All provisions ol laws and oNinances goveming this type ol work will be complefed <br /> whefher specified herein or noL The granfing of a permif does nol presume to qive au(honty to PERMIT# <br /> violate or cancel the provisions ol any other sfate or/ocal la�v regula(ing consfn:ction or fhe E (5 D <br /> pedormanco o(consWcfion. That 1 am authonzed by fhe owner of(hi:property to perlortn tho �.���I <br /> work lor which applicahon is made and 1 compty with(he Slafe Conf2ctors Law 7827 RCW and <br /> 296.200 WAC. <br /> � 6(2/I S <br /> Signalure Dale <br /> REViSEO N.0'q <br />