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APPLICA, .JN FOR E�ECTRICAL�?ERMIT <br />� cin oF EvexErr I <br /> BUILDINC DIYISION � <br /> 3200 CEDAR STREET � <br /> EVQtETT, YA 98201 <br /> 259-8810 <br /> � ANT��, i o s'4y �,za��v D2 �vF�'rn�t �A eac� qY�D/ .�Ph��d� <br /> ner Mai ddress Y P <br /> enant � a d ress ity tate p o�e <br /> TiNNEIL fCECTc��� i7Yo3 �flus<AVE NF IC�aY.1�ac� l�f LC�i�4P�7>- 7SS'lJ98.2 TNNEZ`/O�J�_ <br /> E�ct�r ci� ontractor T�aiTAadress—Cit�-3tate p Phone — t� cen�se No. <br /> ont� ract�rice o or ropose se o u� ng <br /> f�c[�o.rrN 4 �1E�'E71 .rJ�4 98��4� <br /> o�ett ress <br /> DE:.�_,�ic �n•: of Work To Be Done: �"" " " " �' /�� �� - <br /> � NOTE: WAC 296-46-140 REOUIRES_ THAT PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STATE OF WASNINGTON. APPLICANTS NITH SUCH JOBS MUST SHOW THE STATE APPROVEU PUNS BEFORE A <br /> ,CITY OF EVERETT PERMIT MILL BE ISSUED. , . ' <br /> IiOTE: WIRING IN NON-DWELLINCS IS REQUIRED TO BE IN CONDUIT. <br /> I HEREBY CERTIFY THAT I HAVE READ AND' EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS ANG ORDINANCES GOVERNING THIS TYPE OF <br /> OT THE GRANT�� OF AD ERMIT D SENOT PRI SUME TO GIV�E <br /> AUTHORITY TO VIOLATE OFi CI.NCEL THE PRG'JISIONS OF ANY <br /> OTHER STATE OFi I.00AL UW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE aD <br /> OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOH WHICH FEE �`d <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTCRS LA�/'�18.27 RCW AND 296.200 WAC. <br /> X � '��.� S-3 - 9.� <br /> Signature DaCe <br /> ���q� <br />