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, <br /> .� <br /> µ ...� <br /> �: <br /> r'�.�... .�. I <br /> �. <br /> F <br /> . � �- : <br /> APPLICATivN FOR ELECTRICAL t'ERMIT <br /> ��� arr oF e�rsEn <br /> 3 6UIlDING DIVISION <br /> pC„��� 3200 CmM STREET <br /> �H� erEa�, rn 9ezo1 <br /> y �� 259-8H 10 <br /> � �� f __ <br /> 0 0 �� ��� � �r ,✓ �/ � l �v��'.•� %" f }'v , �L,,✓ �� � c,/ .?�b=.�'56�;— <br /> � yH ner a l�i'ddrees ty tace p hane <br /> H <br /> x � <br /> � qy C �7;1�+'1�.Q_ �L1l,�Y')L � �;J��S <br /> Q �y � m�nt a d ress ty tate c p one <br /> r <br /> �H�°g❑ ��- a� <br /> Z M� eET ctrTca ontractor a ress ty ta[e D one tate icense o. <br /> � H <br /> i �� � �-7 <br /> a�,�,SO ��"`»2.921:, <br /> H on[rect r ce o or ropose se o u nq <br /> O �N ' <br /> r�+1 ����l C k'C��C� <br /> Hp V� ro ect d rtss <br /> � I r / —/� •/ <br /> /` �� . 1��.. .j:. <br /> IUiscrlption af Work To Be Done: 1tiv y�1 ( �t / � �y�„Q l�'/ f(,'�' µ . <br />� _ <br /> ��w' � <br /> � + <br /> � � <br /> NOTE: WAC 29G-46-140 REOUIRES THAT PLANS FOR EIECTRICAI NORR AT EUUCATIONAL� INSTITUTIONAL OR flEALTH CARE FACILITIES �, <br /> I� BE APPROVED BY THE STATE OF NASHINGTON, APPLICANTS WITH SUCIi JOBS MUST SNOM TIIE STATE APPROVED PUNS BEFOflE A <br /> ; �"'' ,CITY OF EVERETT PERMIT NILL BE ISSUED. , <br /> i` �� <br /> I NOTE: MIRINC IN NON-DWELIINCS IS REQUIRED TO �E IN CONDUIT. <br />� !' ' 1 HERELIY CERTIFY THAT I MAVE READ AND� EXAMINED THIS � <br />' APPUCA"ION AN�KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />' PROVISWNS OF UWS AND OFDINANCES GOVERNIN6 hi15 TVPE OF � <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />, �•'� NOT. THE GfiANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFITY TO VIOUTE OR CANCEL THE PFOV�SIONS OF ANY <br /> OTHER STATE OR LOCAL UW REGUUTING CONSTRUCTION OR THE <br /> '� .� PEFFOFMANCE Of CONSTAUGTION.THAT I AM AUTHOflIZED BY THE 7L� � <br /> �, I OWNEN OF THIS PpOPERTY TO PER�ORM THE WORK FOR WHICH FEE tfS / �� <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> CONTRACTORS U1W iB.27 RCW AND 296.200 WAC. <br /> r <br /> " I <br /> X f- � vL���(�� LCLI.l.\��._ _7 ' .r W' j � ' <br /> Siqnature Oate <br /> 1 <br /> � <br /> � <br />