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APPLICA1F�JfV FOR ELECTRICAL'�,�ERMIT <br /> ��� �� <br /> �/ ciTv or- n2errr <br /> a''3 —'- aui�niNc orvisioN <br /> ��H �"� 3200 CmAR STREET <br /> r xC/� '� EV[RtTT� MA 90201 <br /> y �Z H 259-8810 <br /> � c� � c�� <br /> � r�i'�xJ ���//'7`� �nm/�rrQ ���'//.h �r �H/.7 C!t/ ,�c�Pi"-./% L��L �i��%'''` '' / <br /> (A H Owner Mai Atldress ity tate �p Phonc <br /> H t" <br /> � z <br /> i y d S�9 ��� � <br /> O H Tenant aiTTdress ity tate ip hono <br /> H �8 <br /> �` n � our F/ � <br /> a � r, � <br /> � y� ectn cal ontractar Mai ddress ty tate ip hone tate ic^nse o. <br /> x . .� <br /> F-iH ���.,,, ,� �,.�.;., ,. <br /> � �N o��-act n cc o or Pro,cacA Usc of BuilOing�� <br /> � [�1 N �) /�.nh o ir'/rl i ' � / <br /> y p y Fro�Pct Atltlress <br /> Discription of Work To Be Donc: —"�T� �/ 9(7�v / c� -�C�' � �'�� >''�'vi ��--- <br /> / <br /> ��� <br /> �� <br /> '� s <br /> � ! <br /> NOTE: WAC 296-46-140 REOUIRES TIiAT PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STATE OF WASNINGTON. APPLICANTS WITH SUCH JOBS MUST SHOW THE SiATE APPROVED PLANS UEFORE A <br /> '� �"" CITY OF EVERETT PERNIT WILL BE ISSUED. . <br /> �� <br /> NOTE: WIRING IN NON-DWELLINGS IS REOUIRE� TO �E 117 CONDUIT. <br /> '�"�`' I HEREBY CERTIFY THAT I HAVE AEAD AND� EXAMINED THIS <br /> APP�ICATION AND KNUW THE SAME TO B[TRUE AND CORREGT.ALL <br /> PFOVISIONS OF IAWS AND OFiDINANCES GOVERNING THIS TYPE OF <br /> i"r ' WOftK WIIL 6E C01dPLEfED WITH YlHEfHER SPECIFIED HEREIN OR <br /> �.� NOT. THE GP.ANTING OF A PER�.fiT DOES NOT PRESUh1E TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OFi LOCAL LAW REGUTATING CONSTRUCTION OFi 7HE <br /> � w�. PERFORMANCE OF CONSTRUCT10�7.THAT I AM AUTHOFIZED BY iHE —� <br /> �I I OWNER OF THIS PROPERTY TO P[RFORh1 THE VJORK FOR WHICH FEE �` � <br /> APPLICATION IS MADG AND I COMPLY WI7H THE STATE <br /> CONTRACTORS LAW 18.27 flGW AND 296.200 WAC. <br /> X � � i_ /� / <br /> :ll: ,,e �ifi' � _ ..-- -----_. <br /> � i:.i t.. <br /> %� Signac re i� i <br /> �, � ,�L-', � �/ <br /> � <br />