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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERM�T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> ���� I�A�I`Sa ��, ��� <br /> PROJECT ADDRESS <br /> ;� <br /> -�t�r� ��� , ��� 2 ' �. � ; �� v� `��e�r-� �,�/�- �z5 2�8,ii4 <br /> ; - <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> ..- <br /> � <br /> Elect�ical Con raCtor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> �j �� y�i ����/�,. <br /> Proposed Use Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: !" ���'Q{ ��� �_ _�S"� (�)`��'�'�,���� <br /> �� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � D�ID' <br /> I hereby cerfify 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 fhe owner of this property to perform the E �� �� — �� `� <br /> work for which application is made and 1 c mply with the State Confractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � L <br /> ignature Date <br /> REVISED 3/20/13 <br />