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ELECT AL PERMIT APF L1CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> 6eXieCkilfr\e) <br /> POJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 's Z/..?"- 731 „I-670 I ee2 /P <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 05-3 8' <br /> State License Number(required) City of Everett Business License Number(required) <br /> PeS CAS—6 <br /> Proposed Use of Building Contract Price of Work <br /> • D41) . tiG—J <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) y� <br /> Description of Work to Be Done: y // 7 s/Ad (D, / <br /> Avd (-d f r e "-' zine <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105431-1 5 -' <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether -eci i:•• herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate •r cancel the provisions of any other state or local law regulating construction or the <br /> perfo, ance of cbnstruction. That I am auth• ed by the owner of this property to perform the E Otic-012_ <br /> wo for which a•plica ' n is ad nd - • ,y with the State Contractors Law 18.27 RCW and <br /> 296 200 WAC. <br /> 67-4' <br /> ignature Date <br /> REVISED 08/06/2014 <br />