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.�.::;::_ <br /> � <br /> � <br /> .<.,,..� <br /> � <br /> 'F; . � <br /> ,,.x: <br /> APNLICATIC�N FOR ELECTRICAL PERMIT <br /> ��y �^r cin or eveRerr <br /> p,��,."C / ^r� BUILDINC DIVISION <br /> �y y I�%�%I 3200 CFDAR STREET <br /> �p�/EYFhErI EVERE7T� MA 98207 <br /> H ���' �� <br /> y �~ 259-88�0 C' -��' <br /> K o /�(� , / <br /> � �'� \ l� l Q� l � • ` %� � '/ / <br /> oxo � ` <br /> •� aiN � i V� , <� ���,�;[ I_� C�, S,fvo�,o,��cl,, l,v f� S " ' / <br /> y Owner ' �Q4ai1 Address ity tate �ip Phone <br /> x <br /> � o�d ��q �,�� <br /> � ��1 enant Mai ddress ity tate ip hon�— <br /> �V n <br /> r HC3 ) l�U/I/-�� f <br /> 9 H L�7 ectrical ontractor Mai Address ity State �p hone tate tcens�— <br /> y <br /> t <br /> n <br /> HH - . �l -�� 0 UL'P G�- <br /> g � �' �� �f� � <br /> H <br /> C� l7 V� ontract rice o Work Proposed Use of Buil�ing <br /> � �r �e7� � — -, .. � ..� <br /> H C�i� / � � �c�'�c c_'-<�% ' �`' <br /> H O fA ro�ect Address <br /> Discription of Work To Be Donc: " � <br /> ��- <br /> 1 <br /> , / � �;�i` ��� \ ,�� `�,l<�(� \ �� �_ <br /> / <br /> '�,�' � L%� y�? � � ✓� l� <br /> �� . <br /> ��� <br /> �,,.el <br /> NOTE: gECAPPROVED�BY THEUSTATETOFTWA.LSFAiINCTON.E`APPLICANTS WITHTSUCHCJOBSNMUSTISHOWTTHE STATE�APPROVED PLANSABEFOREEA <br /> ,,.,�� CITY OF EVERETT PERMIT WILL BE ISSUED. . <br /> NOTE: WIRING IN NON-DWELLINGS IS REUUIRED TO BE IN CONDUIT. <br /> � � I HEREBY CEflTIFY THAT I HAVE FiEAO AND� EXAMINED iH15 <br /> APPUCATIGN AND KNOW THE SAME TO BE TRUE AND CORflECT.ALl <br /> +• ..� PROVISICNS OF LAWS AND OFi01NANCES GOVERNING THIS TYPE OF <br /> `, I WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIN6 OF A PERMIT OOES NOT PRESUME TO GIVE <br /> AUTHOFITY TO VIOIATE OR CANCEL THE Pf�OVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW FEGUTATING CONSTRUCTION OR THE <br /> � ' � PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE _�_! <br /> � OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH FEE <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT,RAGTORS LAW 1827 FCWAJ\JD 296�.200 WAC. <br /> / k \ . <br /> • � � <br /> � u `` <br /> X � � . 1 —� � il _ <br /> � _ , 1 . . <br /> � . � �—�> / /. �( / �_ 1 1/� � <br /> �— ) i�' <br /> 5 i gnature Date i���-' <br /> I <br /> / <br />