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ELECTFRIZICA L PE T APP"GLEN O <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 /> (Qo-7 l7F: ;310 <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address (( City State/Zip Phone <br /> CQ 13300 lc a PM cj NI�Ua Uf <br /> Electrical Contractor Mail Address tity StatelZip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> J; I oo..o <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/ ontact Number/Email <br /> Number of devices (if low voltage) <br /> Description of Work to Be Done: �� ST <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 (^ ) <br /> l 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 E <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296,200 WAC. <br /> Signature Date <br /> REVISED 08106/2014 <br />