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APPLICATi�N FOR ELECTRICAL r�ERMIT <br /> A�� clTr oF FVERE7T <br /> 9 H N � RUIIDING DIVISION <br /> 3200 CmAR STRE[T <br /> H 3 � ', �� LVEREfT� MA 98201 <br /> k �� 259-8810 = s <br /> S. / <br /> � ai� )G'2�/i/5 s-��j/c/l r �i'�/-�5 '�',.��/ f;�--�. !G�`--- �L� ,�-v� � <br /> � ,�,� �ner �uii d res� li[y��Ca[e �p hone <br /> H C7 <br /> O H�y _ <br /> H �Y enant al d re55 [y ta[e .ip 'ho�— <br /> V <br /> � H� FT_::,��� -��t'C�~t �/ ' .. � ,<�— — <br /> y ectr a on ractG e dd�ess �ty tate p honc -3tate �censc o. <br /> r-i H � <br /> g �yy �--� <br /> - : = �__ _ <br /> r ontL ract�r ce o or -Froposod s o fu��q <br /> pl � <br /> � <br /> HON �Y� L•�iC/!�� C- .l�l• �;f- --__ <br /> ro) ct d ress <br /> DiurlpNon of Work To �e Dane: _ .__ _._. ___—__—__._ -- <br /> / <br /> � �����1� � '� �C ��/��� <br /> _T <br /> ' �� <br /> � � <br /> � � <br /> NOTE: MAC 196-46-140 REOUIRES THAT PLANS FOR ELECIRICAL MORR At Cf�U(:h710'Inl., I'�SitiUiIONAL �R NEALiH CAftE FACILITIES <br /> '� �"' OE APPROVE� BY THE STATE OF WASNINLION. APPU C�NTS MItN SU��tI JCPS NU;i Sf10'd iHE STAiE A^PROVCD PLANS [1EFORE A <br /> � .i CITY OF EVERETT PERMIT WILL �E ISSUED. <br /> NOTE: XIRING IN NOY-DWELLINGS IS REOUIRED TO OE IN f.Otlf`Uli. <br /> ( <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNiS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiR[CT All. <br /> �� PROVISIONS OF UWS AND Oi701NANCES GOVERNING h115 TYPE CF <br /> � WORK WILL BE COMPIETED WITH WHETHER SPECIFIED NEREPI OR <br /> �` NOT. THE GRANTIN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANY <br /> ' OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF TNF. <br /> ,�,I I PEPFORMANCE OF CONSTFUCTION.THAT I AM AIfTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOPM TN[ W0�7K FCR WHICN FfF. _�_ <br /> A/�LICATION IS MAOE AND I COMPLY WITH THE $1AT[ -'- <br /> CONTRACTORS LAW 18.27 PCW AN�296200 WAC. <br /> X�\ � . <br /> i >' >�/'� ' �'��� ' _ <br /> Signa[uro � ` ��•'�" <br /> � <br />