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ELECTRICAL IT APPUCATION <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 /> Tenant Mail Address City State/Zip Phone <br /> 5 H*4W �r Peva 6 IgL ST s� c rrvN, -"� 3r� <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> L�cs4Z1y ®Stcz 6d�' <br /> State License Number(required) City of Everett Business License Number(required) <br /> :5 IF,�ie-� CttA-)i!�M ' -' -occ).oC--', <br /> Proposed Use of Building Contract Price of Work <br /> 6 000 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: -�k A-->TA-L� AITw 7,&41 A,'-P Pl+" U:L, <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> l hereby certify that 1 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 E <br /> work for w .s ma n c mply with the State Contractors Law 18.27 RCW and <br /> 0 WAC. <br /> Signatur Date <br /> REVISED 08/06/2014 <br />