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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.org <br /> a 7- 7 "7-"A PA A 1 cAC_. A-- <br /> PROJECT ADDRESS <br /> S f u I Tielc,. U g 'rr wA < '-/ "-'-3sc-/ ..5.2 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Cf--ASS J ,Kc -A tC 0 moi' civ 7-1' `i,G ,-Z,,Scri <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> Go g <br /> State License Number(required) City of Everett Business License Number(required) <br /> Cies 1 oar <br /> Proposed Use of Building Contract Price of Work <br /> 10CAg <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: t® I *® _, <br /> Y2>0 ) L1 N1 -- e—T <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 QOO <br /> /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 E ,^\U, �� ��Z <br /> performance of construction. That?am authorized by the owner of this property to perform the <br /> work for which pli ation is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC /.4,..,....._ <br /> ✓ T <br /> Signature Date <br /> REVISED 08/06/2014 <br />