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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.org <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> c�— "cL'c CVefe U) 2C <br /> Tenant Mail Address City State/Zip Phone <br /> GI n Std N P,CO, F� aX 3 1 7 % c A yq t-3 ?) <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> (321 <br /> State License Number Contras Price of Work <br /> r <br /> Proposed UEW of Building Contact Person (Plan Review) <br /> r <br /> I <br /> Square Footage (If residentia new construction, remodel or addition) <br /> 5— <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: <br /> C. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and 45 o <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 ��r <br /> performance of construction. That/am authorized by the owner of this property to perform the <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and V <br /> 296.200 WAC. l <br /> ignature Date <br /> REVISED 3/20/13 <br />