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APPLiCAI . JN FOR ELECTRICAL ,�ERMIT <br />�� <br />.^.tC.D�10 <br />CI7Y OF EVEk[Y1 <br />6UILDINC OIVISION <br />3200 Cml.if STREET <br />EYcllETT� YF 9B2o1 <br />:,eonard Squire 4426 Hoyt Ave. Everett, WA 98203 259-1440 <br />nner a� 0 iefs <br />�ty tate �p nonc <br />Yena�t a� ress <br />�Y [ate �p �ane <br />IDW—GM4 <br />� mtr ce ontractor �ai tl ross ty �ta[c p anc tata <ense o. <br />���� U� SINGLE FAMILY REPSRESIDENC6 <br />�nVac� rice o or � ropos0 se o u� tl ag <br />4426 Hoyt nve. <br />ro�� ress <br />Nscription of Kork To Oe Donc: <br />LOW VOLTAGE SEC. SYS. j(,9j RES. <br />EMNET�2614-9-5 <br />NOTE: HAC T95-4fi-140 REOUIftES THAT pU1N5 FOIi ELECTRICAL kORK AT ECUCAiIOttAL� INSTITUT�ONAL OR HEAlTH CRRE FACILITIES <br />BE APPFOVED OY THE SiATE OF WpSHING70N. APpLICANiS NI1H SUCN JOBS M.USL SHOW THE STATE MPROViO PLANS BEFOFE A <br />CI7V OF EVHR2�T PEIiMIT WILL BE ISSUED. . <br />NOTE; WIRINL Ili 11pN-DWELLINLS IS PEpUIREO TO BE IN CONDUIT. <br />I HEHEBY CERTIFY THAT I HqVE READ AND E%AIAINED TXIS <br />AGPLICATI011 ANO KNOW THE SAME TO BE tRUE AND CORRECT. ALL <br />PROVISICNS OF L4W5 AND ORDINANCES GOVERNING THIS TVPE Of <br />WORK WILL BE COMPLETED Y/ITH WHETNER SPEGFlED HERBN OF <br />NOi. THE GFANTING OF A PERId1T OOES NOT PRESl1M[ 10 GIVE <br />AUTHORITV TO VIOLATE Ofl CANCEL TN� PROVISIONS OF ANV <br />OTHEii STATE Ofl LOCAI LA4/ REGUUTING CONSTFl1CTI0N OR TME <br />PE�FORMANCE OF CONSTRl1LTI0H. THAi I AM AIfrNOqIZED �Y iHE <br />fWM[fl OF iH15 PRJPEP7Y 70 PERFORM THE WORK FOF WMIr,N <br />APP{,ICA710N I$ MADE AND I COMPLY WITH TNE STATE <br />CONTRACTOFlS LAW I B2l RCW 4N0 296.100 WAC. <br />" Q � �..J� � 9�a�U <br />�� . <br />Signe e Date <br />FEE y��/Y. Q <br />