Laserfiche WebLink
APPLICA� �ON FOR ELECTRICAL r�ERMIT <br /> ciTr oF EVEx�-r <br /> 6UILDINC DIVISION <br /> 3200 CEDAR STREET <br /> EVERETT, MA 98201 <br /> 2ss-saro <br /> L\ � I�^iV� �'I'F n IT C� Sses � 1/tr1 �r � k,1 <br /> Owne� r`�'^'-7 Mail Address (�y � V�r` � � � S � � �7 '� <br /> �ty tate Zip Phone <br /> ien� � ! r. N 0 tl��C. I� � 'f cl L: .,S � L 0 � !" �! I�J n �/ '� r ( 7 �o c>. <br /> nt Mai 1 Addre ss <br /> n City tate Zip �o�e <br /> rnv� � I�or. �� � � . �I/d ?.,x a� � S ��l�.-�f' �erG, � x�� �.--,� �f ��/�j�[�dl,C+ <br /> electrical Contractor - Mai Address ity tate Ztp hone " '3`tate ice se�Jo. <br /> � S,� ���� U S�� � �<� ; L�� � <br /> Contract Pn ce a Work � Proposed Use of Building <br /> � / / I�_ ` <br /> h r (= r � �� c r c I N Q Li . . <br /> Pro,7ect Add�ess . <br /> Discription of Work To Be Done: ����� � . � _. L � _� <br /> �/ � � �IT" / !` �'1 �—�11 C �?���P �� )� -/cs—n 1 T' <br /> i <br /> —_� f� �l I �� ' . . <br /> �� ��� c� 1 � c� <br /> NOTE: WAC 296-46-140 REpUIRES THAT PLANS FOR ELcCTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APpROVED BY THE STATF OF WASHINGTON, APPLICANTS WITH SUCH JOBS 11U5T SHOW THE STATE APPROVED PLANS BEFORE A <br /> ,CITY OF EVERET7 PERMI; WII.L BE ISSUED. <br /> NOTE: WIRINC IN NON-DWELLINCS IS REOUIRED TO BE IN CONDUIT. <br /> i HEFEBY CEflTIFY THAT I HAVE READ AND' EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT..4LL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WOFK WILL BE COMPIEiED N/ITti WHE7HER SPECIFIED HEREIN Ofi <br /> NOT. THE GflANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL TFIE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINia CONSTRUCTION Ofl 7HE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH FEE _ 99� ._ <br /> APPLICATION IS MADE AND I CONPLY WITH THE STATE <br /> CON1'RACTOfiS LAW 1927 RCW AND 296.200 WAC. <br /> x � _ ,�-- . <br /> , ��.�. � <br /> Signature Date <br /> / <br /> 3��p� <br />