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�� <br />259-8810 <br />APPLICATiON FOR ELEC7RICAL NERMIT <br />CIIY OF EVFAE7T <br />WILDING OIVISION <br />3200 Cm�R STRCEf <br />EVERETT. fIA 99201 <br />//��U '�<y _ ��-.�1 ?/Z3 ���vT ��.�F �`.L.'_C� �jh- SYi.�. �5v.��{. <br />1� e� a E ress ty ta[e/Zip none <br />SRr+�C �}S G-f,�,n +�G <br />enan���Siress it�tate/�� oni� e - <br />���:c"2.c. �O 2•x 53S (,�y,�,JJc C�1• �/Cr3•o332 Cor7i�E YN �y <br />ectnca ontrarmr—�i res"T-Idd a CVty �cate Ap A on�'3tace Lc.ense o. <br />% <br />U � � <br />3 ZJ �<F�• i7>l,JG L <br />onVaC�PrTe o or Yropose� U.n o ui ding <br />�,f�Z 3 /{n�r Ar�f <br />ro��<c aa��.. <br />Diacriptian of Xork To 0e Done: �)cy�a±-±�n .�i �iC.-J 'c� /��i 4�� ..�� /�.�. TA' __ <br />/� /� / <br />.�Ui+-.%tcd S!i(ie17i 7'� �,R/Jr��. ��4) C��Ht.2� 0/�-/.f?� YM4_)h�� <br />� � S ! a� � Nc ) �"ih.» -/r[t � �'S���u� C n ✓l` <br />J. ��, r:��� GL�� �grtM» �� !1M-xl L.�.)�' <br />NOTE: WAC 296-4G-1V0 REOUIRES THAT PlANS FOR ELECTRICAL WORK AT E�VCATIONAL� INSiITI1TI0NAL Ofl HEALTH GFE FRCIUTIES <br />�E APPROVE� BY iME STATE OF WASHINLTON. APPLICANiS WIiH SUCH JO�S MUST SHOW THE STATE APPFOVED PIANS �EFORE A <br />CITY OF EVERET7 PERMIT MILL DE ISSUEO. . <br />NOTE: MIRINC IN t10N-DWELLINCS IS REO�IREO TO 9E IN CON�UIi. <br />I NEREBV CERTIFV THAT I MAVE READ ANO' EXAMINED THIS <br />APPLICATION AND KNOW TME SAME TO BE TROE ANO LOPPECL ALL <br />PFOVISIONS OF UWS AND OROINANCES GOVEnNINia THIS TYPE CF <br />WOfiN 1YILL BE COMPLETED WITN YAIETHEi7 SPECIFIEO HEflEIN OR <br />NOT. TME GRANTING OF A PERMIT �OES NOT PRESLIME TG GI'!E <br />AUTHOPITY TO YIOI.ATE OR CANCEL THE PROVISIONS OF ANY <br />OTIER STATE OR LOCAL lAW REGVLATNG LONSiFUCTION OR iME <br />PEFFOFMANCE OF CONSTRUCTION. THAT I AM AUTMOPIZEO BV TME <br />pWNEfi OF THIS PflOPERTY TO PERFORM THE WORK FOR WMICIi <br />APPLICATION IS MAOE AN� I COMPLY WITH TNE STATE <br />CONTRACTORSUW IB.a"7 RCW ANO29fi ^.00 WAC. <br />X'��i ����"�--'�—_ <br />Sign�ture . � 'Oate <br />