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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,arg ! <br /> PROJECT ADDRESS <br /> 7 ii ! <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City StatelZip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Budding Contract Price of Work <br /> Square Footage(If residential new construction. remodel or addition Contact Per n; <br /> 9 1ersa Contact Number/Email <br /> i <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done. �� X <br /> I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � �n 00 <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 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 I am authorized by the owner of this property to perform the 1 <br /> wort;for which application is made and I comply with the State Contractors Law 18.27 RCW and E 5� I <br /> 298.200 WAC. <br /> Signature tN y Date <br /> I <br /> I � <br /> f ' <br /> � aev;sefloart�ev2o�a i <br />