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�-. <br /> � � � APPLICATIuN FOR ELECTRI�AL NtRMIT <br /> C H <br /> y <br /> h] N <br /> 1� � <br /> '° � � �V�r��� <br /> t�a � �a :UILDING DEPARTi�1ENT � <br /> a o 0 59 8810 � <br /> � � �,� � � <br /> M , / <br /> � M <br /> y y Dc { P.+ �`d zZ ��Sr� Sw �� man�s �pu2o 77S �f�b9 <br /> S �y W�«� Mai Atldress <br /> f] O N <br /> � � 1 <br /> u y �CG ` Ma� tltlress �ty p hone <br /> � o y enanc G2 0 �Z. �C Il��� <br /> C �G�fn�c �a� a! yk Sr.t�l Qr,os F " <br /> ectriea ontracmr <br /> Mat tldress �ty ip hone lcense : <br /> .ont ac[ n ce o Work roposea Use a �� 4�^9 � <br /> 2 3o S G v��`ij` � � �� <br /> �ro�ect nT aCress — � <br /> I <br /> i <br /> �istn ption of work o Be one: - � <br /> Ad..l ro ad�i�he�al c/✓e,,,�s �-o exiaf�N : <br /> � <br /> f � lzori,e CL�oura.� �s{�✓« -�-o aoo,4i.,� � <br /> ; �,�, <br /> ra.,-, � <br /> i ` : <br /> � <br /> � <br /> � <br /> � o� i <br /> ��1 � �IOTE: WAC 296-46-740 R�OUIRES THAT PlANS FOR ELECTRICAL WORK AT EDUCATIONAL� INSTITUTIONAL OR HEALTH CTRE fACIU TIES i <br /> CETYPOF�EVERETTTPERIITTWILL BESISSUEDt+ APPLICANTS WITN SUCH JO85 MUST SHOW THE STATE APPROVED PLANS BEFORE A ' <br /> i <br /> 'IOTE: WIRING IN NON-DH'ELLII�GS IS REOUIRED TO BE It� METAL RACEWAYS• . <br /> � �0 ' <br /> �� ' I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS f <br /> �i �t�I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL � <br /> � PROVISIONS OF IAVJS AND ORDINANCES GOVERNING THIS NPE OF ��%k'='?i�,B. � <br /> NOT. THE GRANTOING OF A ERMIT DOES N0T PRIESUME TO GNE '. <br /> " =1v�' AUTHOFITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY i <br /> _ OTHER STATE OR LOCAL LAVd REGUTATING CONSTRUCTION OR THE / �'— <br /> ii PEaFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE �3 <br /> ' qOppI.ICATIONfSISRMADE ANDPE COMPLY WITOHKTHE STATE FEE �� �7 <br /> I <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. I <br /> __ X � 3 ; � 35g �o � <br /> Signat re Date � <br /> :;:,t,,'-. <br />