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�`• <br />CITY OF EVEREfT DATe: l�-`i - 8� <br />ELECTRICAL WIRING FERMIT APPLICATION F—: <br />.'.OB AOCRESS � 3 � �V,rv��q2� <br />TENANT ��'3 ��--x—t � <br />FRC?��"�'TY OWhER <br />ELECTRICAL COMTRACTOR .`�' �-,� �.��� ��� � r. �, <br />E� EC. CON'i RACTOR' S MAILSNG ADCRE�o � 35 01 \ ��3 Z� ��_ w ��M�� pC <br />LICENSE N�. ��.Nl.�l��l C r� EXFT_RP.-1pN DATE S- q I <br />ACM_TNISTRAT�i �� � t� V �21�C' Z, PHONE N0. 'Z � �, _ �� � � <br />VALU� OF �YORK (Co not include t�xes) <br />(`or commercial work) <br />U5� CF BUILDING � � � <br />N�Tc: 4lAC 2°6-46-140 *�pU1.=5 th2t p].fln5 TO_ 2�BC��ica1 �Hark dt educational, <br />ins�itutional or health c2re facilities be approvec by the Statz oP <br />Wasninaton. Applican�s with sucn jobs �,.ust show the State-approved plzns <br />ber"ore d C].�`.y Oi Ever=tt permit will he issued. <br />i9GRK TO 8� DOtJE: <br />SIGNEJ : �'—\��.,�y�� •- DATE 1+� Y-�`Z <br />- '� -- � <br />NOT=S AN� �tyMMENTS: <br />