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APPLICATI�ON FOR E�ECTRI .����T <br /> _ �„ � D <br /> 9�J(d�C7 � JUN - 9 � Dcin oF Ev� <br /> � � <br /> 995 <br /> EUILDINC DIYISION <br /> {, ......... ................................................... 3200 CmM STREET <br /> CITY OF E1�ERETT ���r, MA 98207 <br /> 259-8810 r Public Worka: Dept. <br /> / / � �/ 2700 �Gl��ve <br /> �j��i'L'� /��GC7"7�a-l' ��C'�c' ty �GC7�.�� `�/er �✓r'-f'�� <br /> rner Mail Adtlress ity S[a;:e7�p Phone <br /> /i /L�YI�� �h�17 0�7�1� �G��j�t��l�� ���D��_S ateT � �� hone <br /> �nant Mai A� tldress Y P <br /> � C ,� e. �O /� � -�779e0 <br /> 0 hrttn a � 33�a S�a r/�� �%/�- 9�/3.3 oC./,I/Z/ �o�J3 <br /> ectric 1 Cont actor Mail Address ity tate ip hone tate License No. <br /> G(� 3 3 �, �(� ;fNa� � /n�,0/ZvtsN ur,-� <br /> �ntract PrvEe of Work Proposed Use of Bui ing <br /> a�7�n /�„lhU Ave �c���c #��al <br /> oject Address � ' . <br /> scription of Work To Be Done: �� ���'�YS � v/�r ] �ld�=/ ��l ��%�`�i <br /> � ��ti�C� <br /> iOTE: WAC 296-46-140 REOUIRES THAT PlANS FOR ELECTRICAL WORK AT EDUCATIONAL� INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STATE OF WASHINGTON. APPLICANTS WITH SUCH JOBS MUST SHOW THE STATE APPROVED PLANS BEFORE A <br /> CITY OF EVERETT PERMIT WILL BE ISSUED. .. � <br /> OTE: WIRING IN NON-DWELLINCS IS REOUIRED TO BE IN CONDUIT. <br /> I HEREBY C�RTIFY THAT I HAVE FEAD AN�� EXAM�NED THIS <br /> APPUCATION.4N0 KNOW TNE SAME TO 8E TRUE AND CORRECT.ALL <br /> PFOVISIONS OF LAWS AND ORDINANCES GGVEnNING THIS TYPE GF <br /> WORK W�LL BE COMPLEiED WITH WHEi11EA �PECIFIED HEFEiN OR <br /> NOT. THE GRANTING OF A PERMIT DOES 40T PFESUME TO GiVE <br /> AUTHOAITY TO VIOLATE OF CANCEL THE PROV�SIONS OP ANY � <br /> OTHER STATH OR LGCAL L1W REGUWTIt.G CCNSTRUGTICN OR THE <br /> PEFFORMANCE OF CONS'I�UC710N.THAT I AM PUTHOFiIZED BY hiE —��, 1 � [ <br /> OqppLEICOFONISISFMADL�I ANpPERCOMPLY WIT�HKTH�E STATE F� d'7 <br /> CONTRAC70R5 LAW 78J.7 fiCW ANO 29fi.200 WAC. <br /> x . ,.�� i�a��/� ���-�9s- <br /> Signature Date <br />