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1 <br /> r <br /> � _ , <br /> APPLICATION FOR ELECTRICAL PERMIT � <br /> ^�yV��� c�n oF er�Err <br /> BUILDING DIVISIOIV <br /> 3T00 CmAR STREEi <br /> EVERE7T, MA 98201 <br /> 259-8810 <br /> T/�'1 L3/L�cu�_ i� 4 ,n.n / .vbG/,f� ,Eu�2,��� 9,g'v3 353 - 4GL•G. <br /> ner TaiTAddress . �ty tate]Iip Phone <br /> .e� ai� ress ity tate ip hone <br /> �P_ 3 <br /> ��ical ontractor ai ddress ity State ip one tate icense o. <br /> S i-/,� <br /> ontract rice o or roposed se of ui ding <br /> �.rt/1 6 <br /> ro�jc��:t ddre� <br /> DiscripY{on of Work To Be Oane: .e /"�C_ � bG o2 A—Dm/ %/ O �'CI . <br /> � �. _,�./f L o G-.a--T$ /�l� .1r S s�C C� [L <br /> NOTE: WAC 296-46-140 REpU1RES THAT PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STAT� OF WASHINGTON. APPLICANTS WITH SUCH JOBS MUST SHOW THE STATE APPROVED PLANS BEFORE A <br /> CITY OF EVERETT PERMIT WILL BE ISSUED. .• <br /> NOTE: WIRING IN NON-DWELLINCS IS REQUIRED TO BE IN CONDUIT. <br /> I HEREBY CEFiTIFY THAT t HAVE READ AND� EXAMINED THIS <br /> APPl1CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.�1LL <br /> PFOVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HEPFIN OR <br /> NOT. THE GRANTING OF A PEHMIT DOES NOT PR'cSUME TO GIVE <br /> AUTHOFiITY TO VIOLATE OR GANCEL THE PROVISIONS OF ANY <br /> OTHER•3TATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR T}iE <br /> PFRFORMANCE UF CONSTRUCTION.THAT I AM AUTHOflIZED BY THE / <br /> OWNER OF THIS PHOPERTY TO PERFORM THE WORK FUR WHICH FEE ��� <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> �j� �//� /o !s�.�L �f 5/%� <br /> Signature Date <br /> _, ��Sy � <br />