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ELECTRICA
<br /> € T r PERMIT »�
<br /> e Aapl~ICATION
<br /> �vaisE�ors�r�+ra ti�j 425-257-48 10 � � ����� �tT �f2+JiG��
<br /> € Ax 425»253. {?CES STREET
<br /> _. E1t357 € �) R�7T.Yvfc'`�87ot
<br /> PROJECT Ap :z " ` 9ov€ �+E`ww 9w, .,.to
<br /> CRESS: � _. - ' T
<br /> PROJECT TYPE: ` A Y� I/ r"p¢ t
<br /> NEW CC3NSTrl{ BUILCllt�3 A_ 44
<br /> BUILDING usE t��ataplTlc�l� C�TENANT rna � _sq tt
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<br /> CONTRACT PRICE OF WORK: € a :' - IF,C RCI zk
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<br /> DESCRIBE SCOPE OF ASSOO IATED gu#LD# a
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<br /> WORKAi. I F{ PERMIT 11
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<br /> THIS INSTALLATION INCLUDES THE F. IPI
<br /> ISE VOLTAGE WORK? {� '.'",:4`:.!.''S'-'.:'
<br /> c :.ECT ALL THAT APPLY)
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<br /> LOW VOLTAGE WORK NO Fmeder, lre "rcuiYs r. . im- Ljp€e r Re-
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<br /> SELECT SCOPE tt�E��E�EC} El Data 0 tntrrrccsr�, �^�t
<br /> L....l melt In Audits a secure Access
<br /> Fire0 Aiatm-lnstallatatns ° System
<br /> Fire errrm Permit st tinder tlz€s permit only iradwde electr€cal wiring rough-in of the system
<br /> req red for review ofd location and iris eticrrs apprasval A`asiti ttal
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<br /> Other(IJst All)
<br /> IS THIS PERMIT EC?UCATION.INSTITU flONAL,HEALTH AND/Oft PERSONAL CARE FACILITIES. i, NOted
<br /> * YES--Sam Below 8 op•2
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<br /> checking this box,I am stating that I have read and understand all of WAC 296468400, d
<br /> 1-1 of this application{sip Next page),AND Plan Review is NOT required because I meet
<br /> all of fcaltowir�g�Isub sections the
<br /> „fitrt pane 2
<br /> see Page 2 require Plan Review,
<br /> ARE YOU AN OWNER PERFCIRINING WORK AS THE CONTRAGTORWIT 1 "'.ELECTRIICAL I ENgtft iNO AYES
<br /> Pursuant to RCW 98,28, 61,pro rty owners and leaseh it t Clttt3t perform el et w on bumf,> 9$Ior r t sate, 4 7.,
<br /> Ivitl ttstlt the proper eiettn I Incensing 8txi�c tlea a a�� ting * €rag that I haet+r
<br /> 8 snrucsp AFFIDAVIT ox 3 of this apply't '
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<br /> OWN--sePa NAME. �` \��"--�
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<br /> OWNER�I
<br /> LING A ORE58: •
<br /> OWNER >, �; � := tNER i
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<br /> CONTRACTOR ADD
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<br /> CorvTRAr�Tc t PHONE: CONTRACtt t $r'�"�,A ' a r hII'S.r,�?•. z V .(*3.411
<br /> CONTRACTOR LIC #4REQUlRED: 'p` " ( » �' ) c I IC. REQUIRED: ' ,,. : Ill
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