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�;1TY IJF EVERETT <br />APPLICATION ,rq <br />ELECTRICAL WIRING PERMIT^ <br />JOB ADDRESS -230 / - <br />USE OF BUILDING <br />PROPERTY OPIII <br />CONTRACTO <br />VALUE OF WORK (comm.) — <br />WORY. TO 13E DONE: <br />✓ NEW <br />'' WIRING <br />SERVICE <br />ALTERATION <br />LICENSE NO. <br />TELEPHONE NO <br />REPAIR <br />NUMBER OF CIRCUITS <br />NU,HBER OF CIRCUITS <br />120V <br />120V <br />REPLACE <br />240V <br />240V <br />/ AMPS <br />FORCED AIR FURNACE l _ ✓ K.N. (MECHANICAL PERMIT <br />f O �/ <br />�X _ ALSO REQUIRED <br />BASEBOARD TOTAL 1 _ /W 0 fej <br />DESCRIBE WORK TO BE DONE A � A +tiyo.Gc.2�-� <br />��,Zz,z <br />SIGNED By. .G DATE <br />DO NOT WRITE BELOI•1 THIS LINE <br />NOTES & COMMENTS <br />TOTAL FEE <br />APPROVED BY <br />DATE <br />FEE SCHEDULE ON RjEVERSE SIDI7 <br />f- <br />