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ELECTR C ,. PERMIT APPLICATION <br /> EVE .E T T CITY OF E IERETT PERMIT SERVICE, <br /> %r esteems <br /> 01.4254$74910 FAN 4' # ARSTR T VERI T i,WA 2 .t <br /> (E everette i ereltata gov I war, a <br /> 3jW n fib^:Y ,: <br /> l ist St `�y •.. <br /> PROJECT ADDRESS: 1500 In ,. <br /> UIL}I { AREA <br /> FSR T'TYPE. Li New CONSTROcnoN. CIT"oNElNT I o r T I B i I L , ,. <br /> CO CT Pme OF WORK:$ 550 <br /> ASSOCIATED$ :: :� s. <br /> D $ I=E SCOPE OF K . <br /> [nstall t6 whips'tottery Iowerfor repairsdueto burst water pipe <br /> i <br /> THIS INSTALLATION INCLUDES THE FOLLowING SCOPE;(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO E3 YES,-Select Scrape:0 Service 0Feeder 0 Circuits-#:6 ii,' i. <br /> lie-urlre <br /> . <br /> LOW VOLTAGE WORK? NO 0 YES#ctf Desi <br /> SELECT SCORE oitEcuips.4 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access <br /> rity=Systerrti <br /> 0 Fire Alarm m Inetalistiena under this only include electrical wiring ro *title tem,An additional <br /> Pee Alarm Permit for review of device location and ins it • <br /> • F <br /> Other NM Alit_.. _1 <br /> ISTITS PERMIT EDUCATION;INSTIT TI0NAL, iPERSONAL CARE FACILtTIES3 NO . YES- r elow S Pg. <br /> By chocking this boxi i am stating that I havefted and understood alt of WAC 296.460,930. , cts Ts eason on page2 <br /> of this plication(see next page), Plan ; -is NOT requi I because I � of the fd. sad— ' that do not <br /> gee Poo 2 r + : Plan Rev'i <br /> you AN OWNER PERFOIRMINS ,REAS THE CONTRACTOR WITHOUT ELECT'RICAALLICENEURE:IZINO e Bolo"P ,3 <br /> PursuantRCW 19„.28„261.,p ���� >l•eciri -n .`, :sem,or tease <br /> withoutproper dle 'i. l' #FB ,'._>g or exerrtption. y c ecltl g this brace I star ::t i :,,,r later and <br /> s000soe signed AFFIDAVIT 3 of to receive an a rrption from i ,.,, °tt. <br /> OWSERN : E: Leading Edge Gy st ANT BUSINESS :Ainif Cott me "�:.;. ng e°*" Gymnastics <br /> OWNERMAILING A ��r s <br /> 1500(nd : t <br /> r <br /> H <br /> 5 98203 <br /> OWNER PHONE.425 407-1480 ,OW ER EMA L: <br /> ONTRACTOtt.NAME: t eT (ectrico Inc <br /> CONTRACTOR ADDRESS; siREET 8119 249th-: t.:8W....... <br /> Et#mttn S WA i. 96026 <br /> • <br /> C <br /> CONTRACTOR PHONE: 206 .Cm t.9N € A <br /> CONT TOR LIC.#II OUIHED): )V R 'CIL CITY OF EVgli—LIT BUSINESSti *REQUIRED,:. C. 117 <br /> PRIMARY CONTACT: (DL1CO COR 0T to t(Please ):- <br /> CONTACT ¢_ CONT CT 2 367-7 0 <br /> Karen Hanson <br /> COSIt`At'.TT ,All.: enbtlyre . cirorn <br /> iGlbw <br /> � ' , _ <br /> +T:t Pla / r eantt 4 m ttr�' o or asyts <br /> 412e atutotk wa eta srsx , The w,. ottpretYeaC , r ;: ssuernt r�iisr sirutbor perfi t rlam; dJ ' y ofBi ,Use <br /> with C Law 18.27 Wl t IrtliTT <br /> EM i <br /> � to 8� �« t _ : �t r � „ <br /> i <br />