Laserfiche WebLink
APPLICAI:�JN FaR ELECTRICAL . �ERMIT <br /> cin aF ���a� <br /> ��� 6UILDINC DIVISION <br /> 3200 CmqR STREEZ' <br /> >�7 259-8 � ���Ta KA 98201 <br /> >y� T .Gnzales >307 Cr�%�y� /��'� <br /> � n(� / <br /> � <br /> H ,��,� Onner �Q r +tail Address o� C��'rT "��.� �c�� ��/.�5/�` <br /> J'ZJ'e <br /> K n ��tY tate Zip Phone <br /> H 77 --�-------_. . .. <br /> enanT t-- <br /> � (Hq�—�j Mai 1 Address <br /> � O� �� � �tY tate ip --' Nhone <br /> l--�----1 ET�D <br /> y d �lectrical ontractor Mai ddress <br /> � �O �ty tate ip hone — <br /> tate icense No. <br /> 6�� C] _� <br /> z H� ontract Price o Work ���n/ u�a� G�_ <br /> Proposed Use�ui�d{,i9 <br /> � 21 C �7/ ^' <br /> r ~y �G M � .�-,^C� <br /> g � rro� ct Address <br /> H <br /> n d❑� � <br /> [�t" Discription of Work To Be Dar;e: ��/��+� j�(JS � //� <br /> � � / "-/ 'v� l U�/J'� <br /> .y.�� _ ! l / /Z- L� L9 �j— 't J /�-��) I�N,_✓ ,�4 .u�•.J� <br /> '��' - <br /> ..A.,Oe. <br /> NOTE: WAC 19G-46-740 REOUIRES THA7 pLqNS FQR ELECTRICAL WORK AT [OUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> t,�, .w �E APPROVED BY THE STATE OF WASHINGTON. APPLICAt:TS WITH SUCH JO85 MUST SHO'd THE STATE APPROVED PLANS 6EFORE A <br /> � CITY OF EVERETT PERMIT WILL BE ISSUED. <br /> �,.. �, <br /> NOTE: 'NIRING IN NON-DWELLINGS IS REOUIRED TO �E IP! CONOUIi. <br /> eT^' oa. <br /> '�"� I HEREBY CEFiTIFY THAT I HAVE READ AND� EXAMINED THIS <br /> APPLIClQION AND KNOW THE SAME TO BE TRUE AND COFRECL AL! <br /> PROVI��IONS OF L4WS AND OFD�NANCES GOVERNING iHIS TYPE OF <br /> ����"� WORK WIIL BE COMPI.EfE�lYITH WHETH�q SPECIFIED HEREIN OR <br /> NOT, 'fHE GRANTING OF A PERMIT DOES NOT PflESUME TO GIVE <br /> AUTYORITY TO VIOI_ATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR TNE <br /> "a PERFOqMANCE OF CONSTRUCTION.THAT I AM AUTHOAIZED BY THE <br /> �y.:>�,9 OWNER OF THIS P�?pPERN TO PEqFOFM THE WORK FOR WHICH "' <br /> APPLICATION IS M�DE AND I COh1PLY WITH THE STATE FEE <br /> CONTRACTOR�IAW 16.27 RCW AND �6200 WAC. <br /> f,�'�� _�_._..._ / <br /> �� � � <br /> X ' � I� / <br /> �� % � �� -G/�� <br /> {_ $ gnature Date <br /> C <br /> ��I1 <br /> ; <br />