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�1PPLICATION I'OR �L�CTRICAL P�RMIT <br /> CITY OF LVERETT <br /> I3UILDiNG DIVISION <br /> 3200 CLDAR STREGT <br /> GVFRETT, WA 98201 2.59-8810 <br /> QA„�s a- l�oN1�5 50�3 CI-NRi' KoNr w� �uC,��/T �aa3 �S'9-31� 3.. <br /> Owncr Dtail Addrr_as Ciry Statc/Z�p P6one <br /> 'Pcnant Meil Addre.as City Statr./7_ip Phone <br /> � <br /> �;;��.; r � s �.��r�� �7�� I..i��Arvan P� ?�3 s�. ��►y� �8a.��b� R��d�s �f� <br /> Electrical Contractor Mail Address Cily Stale/Zip Phane State License No. <br /> ;�v�', <br /> Contract Price of Work Proposed Usc uf IIuilding <br /> �v�' 3 C I�H�t21'ibl� �j[ � O '��� <br /> Project Address <br /> Ucscription of Work lo IIc Donc: ��� I )��Ub C �/�C V' r �� J �� ��'/"I f J O �1��.�"T <br /> 01� /4 5/6�✓ <br /> NOTF:\VAC 296-46-140 REQUiRFS TF�AT PLANS POR ELECTRICAL WORK AT EDUCATIONAL, INSTINTIONAL OR <br /> ]IEALT}1 CARL• FACILI'I7GS iiE APPROVED IIY THE STATE OF WAS}iINGTON. APPLICANTS W1T13 SUCH ]OBS <br /> MUST SfiOW TIiL• STATL APPROVED PLANS BErORL CITY OF EVERET PERMIT WILI.BE ISSUED. <br /> NOTG:WIRING IN NON-DWGLLiNGS IS REQUIRLD TO I�G IN M[TALLiC RACEWAYS (MC AND AC, ARE CADLES, <br /> NOT RACFWAYS). <br /> I HERGI3Y CERTIFti' THAT 1 HAV@ READ AND GXAMINED THIS APPLICATION AND KNOW THG SAME TO BE TRUE <br /> AND CORRL-CT. ALL PROVISIONS OF LAWS AND ORDINANCLS GOVERNING THIS TYPE OF WORK WILL BE <br /> Co�1PL[TED WITfI WH6THER SPECIFIED HGRLIN OR NOT. THE Gnr,NTING OF A PERAIIT DOES NOT PRESUME <br /> TO GIVG AUTHORITY TO VIOLATE OR CANCEL T}IE PROV151ON5 OF ANY OTHER STA7'F. OR LOCAL LAW <br /> KEGULATING CONS7RUCTION OR THG PLRPORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNf:R OT THIS PROPIiRTY TO FERFORM THL WORK FOR N'}�ICH APPLICATION IS �1ADE AND I COMPLY WITH <br /> 7'HC• STATE CONTRACfORS LAW 18.27 RCW AND 296.200\VAC. <br /> _� <br /> J �. <br /> ` � / 0 /�'/ j Fee � <br /> ---� �c J <br /> Sign. ure / Date i <br /> . �� <br /> �`) ���� <br /> de�.rr P�Sro�) <br />