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low <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.gov <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant / Mail Address City State/Zip Phone <br /> �Dgoxc(sZ- Al —(Zc)� ",), 17 YZ7S_ <br /> T <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> JL <br /> State License Number(required) City of Everett Business License Number(required) <br /> �oyx rc�i� 1?2r 00 <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> 6 <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: 2F,-"15,�r�� t�7/l 5— 0,4-7 4 13 L1 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �V <br /> I hereby certify that 1 have read and examined this application and know the same to be true and t <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the ` <br /> performance of construction. That 1 am authorized by the owner of this property to perform the t <br /> work for whic application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA <br /> (',//Signature Date <br /> REVISED 0810612014 <br />