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<br /> ELECTRIC�4L 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.or
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<br /> PROJECT ADDRESS
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<br /> Owner Mail Address City State/Zip Phone
<br /> Tenant Mail Address City State/Zip Phone
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<br /> Electrical Contractor Maii Address y State/Zip Phone
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<br /> State License Number(required) City of Everett Business License Number(required)
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<br /> Proposed Use of Buiiding Contract Price of Work
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<br /> Square Footage(If residential new constructio , remodel 'tio Contact Person/Contact Number/Email
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<br /> Number of devices(If low voltage)
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<br /> Description of Work to Be Done: �-��-;r�°'��, �� � ���l`�:��"z�,�'° �-, � f��, �� ) ��-_ � ��., , �--r:��l)`��
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<br /> FEE
<br /> CITY OF EVERETT L AL SALES TAX CODE IS 3105 �"I '���I�
<br /> l hereby certify that l have read and examined fhis 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 nof. The granting of a permit does not presume to give aufhority to PERMIT#
<br /> violate or cancel the provisions of any other state or local law regulating construction or the ��� �� f ���
<br /> performance of consfruction. That I am authorized by the owner of this property to perform the
<br /> v✓ork for which appl�fjb°n�s made and l comply with the State Confractors Law 98.27 RCW and
<br /> 296.200 W�1'C. �� '�
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<br /> Signature Date
<br /> REVISED 08/O6/2014
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