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APPLICATIC�N FOR ELECTRICAL PERMIT <br /> �i� -�7o <br /> �� eirv aF eveaaert <br /> WIIDING OIVISION <br /> 3200 [mAR STREEf <br /> EVEREfT� MA 98201 <br /> 259-8870 <br /> �I// t i—F�.�+ rrod .Z.9ol .Lo».h=•,p Fiv�..0 'u-� 9P.2e3 <br /> ncr Ma ddross ty State/ p one <br /> Sa.�-� V <br /> TcnanC a� dGrass �ty Cate �p hanc <br /> � � � <br /> ectnca lontracGor a ddress �ty [ate p hane ta[e uense o. <br /> onir�� Q�TJ �G� �� �-'� S2��r <br /> e a ar �roposc� U,c of u� tl�ng <br /> 2�0 / �(om (7.�.-cP <br /> F�o ect ddress <br /> �iscription of Work To �e Oone: /�/�i� rlo ��ew QCo ({ Se 6 ainc� <br /> `-'�- �v "�I `V-- l. �1 <br /> v' <br /> NOiE: NAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL WOPK AT EDUCATIONAL, INSTIiUTIONAL OR HEALTH CARE fACILITIES <br /> BE APPROVEO BY THE STATE OF WASHINCTON. PPPLItANTS NITH SUCH JOBS MUST SHOW THE STATE APPFOVED PLANS BEFORE A <br /> CITY OF EVERETT PERMIT WILL BE ISSUE�. . � <br /> IlOiE: WIRINC IN NON-�WELLINCS IS REOUIREU TO BE IN CONDUIT. <br /> i !1EREBV CEflTIFY THAT I HAVE READ AND E%AMINEO THIS <br /> APPLICATION AND NNOW THE SAME 70 BE TPUE ANO COflRECL AlL <br /> FFOVISIONS OF LAWS AND OF�INANCES GOVEFNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WI1H WHETHEfl SPECIFIED HEFEIN CR <br /> NOT. THE GRANTING Of A PEFMIT DOES NOT PPESUAIE TO GIVE <br /> AUTt10RITV TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW flEGUU1TING CONSTFUCTION OR TNE <br /> PEFFOFMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BV THE 'lj/��U <br /> OWVER OF THIS PPOPERTY TO PEPFORM THE WOFiK FOR WHICH FEE <br /> APP�ICATION IS MAOE AND 1 COMPLV WITM THE STATE <br /> CONTRACTOPS LAYJ 10.27 FCW AND 296.200 WAC. <br /> X?��� L-�-'•/.M���•�+-.'�i /O/�5�/.L� <br /> / <br /> Si9nacure Date <br />