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ELECTRICAL PERMIT APPLICATION <br /> i <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 �os- 159 , _Z) <br /> JA,Lka Y),A A bc.A A--7 r AGI` V , &Ur- } & e, <br /> Owner Mail Address City State/Zip Phone <br /> I <br /> I <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address city state/Zip Phone <br /> IS CI <br /> t - <br /> State icense Number(required) City of Everett Business License Number(required) <br /> [CL; C <br /> Proposed Use of Building Contract Price of Work rC?4'X 1 cwr <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> I <br /> j Number of devices(if low voltage) <br /> Description of Work to Be Done: <br /> i <br /> I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that t 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 /V�tl <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Sigh, C Date <br /> i <br /> i <br /> REVISED 0=612014 i <br />