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� ro <br /> b � <br /> � � � APPLICATIuN FOR ELECTRICAL NERMIT <br /> O i0 O CITY OF CVERC7T <br /> � � ,r�+ � � 6UIIDING DIVISION <br /> r � 3200 CF1lAR STR[ET <br /> � I'� EVEAETT� MA 98201 <br /> � <br /> � � � z5s-as�o <br /> M �' <br /> pC M <br /> �! � / -�- � �'/ �cif L' Y �fl G<-�i-� ��;z i <br /> r H i. . ' " �� �� ' �ty tate P hone <br /> y ^'� ' � ai ddross <br /> �y ner <br /> � H __ <br /> M �� itY tate p a°° <br /> O � enant a ress <br /> , � � � � C ' 2j �i ' �'_ '�2�a <br /> � G, �G�� / �' tate �+cense o.`�, <br /> . � y� -' � t ` tate p one ���.T�.�Irnz.S�% <br /> ectr ce .ontractor <br /> a� ress Y <br /> � ' C' • / ��' k-� <br /> ropose s o ui d ng <br /> ontrac r ce o lort <br /> _ �� . � — <br /> ro ect ress ^� �y <br /> � � �L� r,/ -1 L�•�/- ' ?I'ilJ�� <br /> i�� �s�� ri r ,� T � <br /> DSscriptian of Mork To Be Done: � <br /> I C� <br /> I ._� <br /> ��� <br /> I �� NOiE: BE�APPROVEO�BY THEuSTATETOFTWASNNNGTON.ELAPPIII:ANTS XITHTSUCHCJOBSNMUSTISHOWtTNE SiATERAPPROVE�CPLANSAOEFOREEA <br /> CITY OF EVERETT PERNIT XILL BE 155UED. <br /> NOTE: WIRING IN NON-DWELLINCS IS REpUIREU TO BE IN CON�UIT. <br /> �� <br /> I HEREBY CEFTIFY THAT I hAVE READ AND� E%AMINED THIS <br /> � '� APPIICATION ANO KNOW?HE SAME TO BE TRUE AND COfiRECT.PLL <br /> PROVISIONS OF UWS AND OFDINANCES GOVERNING?HIS TVPE OF <br /> I�� � WORN WILL BE COMPLETED WITH WNETHER SPECIFIED HEREIN OH <br /> NOT. THE GFANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br /> � AUTHORITY TO YIOUT[ OA CANCEL THE PROVISIONS OF ANV <br /> I pTHEP STATE OR IOCA�LAW AEGULATING CONSTRUCTION OR THE (� � <br /> I � PERFORMANCE OF CONSTAUCTION.THAT I AM AUTHOFI2ED BY THE <br /> I '�1�+� OWNER OF THIS PROPERN T(� PERFORM THE WOHK FOR WHICH FEE — <br /> � APPLICATION IS MADE AND I GOMPIY WITH THE STATE <br /> CONTRACTONS UW 1827 RCW AN�96.200 WA%. <br /> � / <br /> X ����`� _ <br /> Date ��� <br /> Signature <br /> r <br /> r�) <br />