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� <br />CITY OF EV6RBT'C <br />SLECTRICAI. WIRING PERMIT APPLICATIOH <br />J06 nUDRESS 5 � Z <br />TEN7INT SA <br />PROPBRTY OWNER 'E�U� <br />6LECTRIC7IL CONTR/�CTOR <br />Cot.By <br />� /E-S OW N E � <br />c� �--� J L �= 4 COu�..IT7tM L fr �[� <br />'c,J,r-�G FLticz-+z/c <br />CONTMCI'UR's nn�tzrss _ 5 j`; /�A-�� ST. __ F b�NA t r1 �' �' 1. v <br />CITY ZIP <br />LICGN56 ta0. Fu%��C� /S33 8G EXPTRATIOII Dt+TE � <br />nDi•fI:7I5TRn4'Oli PIIONG tJO. ,T I Q �_7 �/� <br />vALUC•. oC woRK 9��'7O (do not include taxes) <br />(for commerical work) <br />USE OP DUILDING �1 wMP ��°`SE - 122���/h�orv <br />NOTE: WAC 296-46-190 requires thal plans for electrical worlc at educational, <br />insl'iLUCional or health care Iacilities be approved by Che State of Washington. <br />ApplicanL-s with such jobs must show Che SCaCe appr.oved plans befoxe a City <br />of Gverett permit will be issued. <br />N01'L•': Wirinq in non dwellings is required Co be in conduit. <br />D/1TE 5 � l 4 ` � / <br />FEE <br />WOIiY. 7'O f3E DONC: <br />•1�_�N,r�s (�z.) i 1��Calir, �Y�,,4�N ei£.•tK4�L (z.�.�a,+'�as) -f�,o/zv% ✓Jtr,'ic,E <br />sicN�u: /�---�9 7�liLt�� Sur'%. on1•�: S'-a4 -9i <br />� , <br />3/:7/90 <br />' , R'q� ..s' I'�:.i�iil. ...!."; ..r�/:$��iC^i�h:�}'.y�. ..�i�.����•�t�,�[�7[iL:1���:�1_ . ��.1�"����J1.^.�. iv7� r��� .w.. <br />A ' i � ZI' <br />