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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 /> 3 367S 1\for4ork Ave • vPre�� <br /> PROJECT ADDRESS <br /> l 33cJ Nor'LA Avv C`VernTt w . -La20( 4125_876-36s7 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> W <br /> Electrical Contractor - Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <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: It `1171- (r4clikaS CO lei 4 Co,in it144-5 1)0442 tr)1TS') t..ttriv f'c7;r\ -e <br /> AI I t v>lnCc`t€(1 o. �kcrkel< <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS,3105 <br /> 752-- <br /> I <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 thef <br /> performance of construction. That I am authorized by the owner of this property to perform theE 1 ti- <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 0/27 <br /> Signature Date <br /> REVISED 08/06/2014 <br />