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•-� <br /> � <br /> CITY OF EVERGTT DAT'E �/ Ct� '- /C� <br /> ELECTRICAI. WIRING PERMIT AYiLICATION FEE� <br /> JOB ADDRE.iS ��L� fo[ Y /�//��Q ' <br /> n �i r <br /> TENANT J <br /> PROPERTY OWNER �.�y/v .� {y�/✓O�-�S n �/ _ <br /> ELECTRICAL CQNTRACTOR J�L �/�� L/C L <br /> CONTRACTOR'S ADDRESS y(n �,� �7�/���SG SNO /(} �/ � I <br /> � � <br /> CII'Y ZIP � <br /> LICENSE NJ. E � CG-C� /SG k9 � EXPTFATION DATE _ ��-� /,L <br /> ADMINISTRATOR ,(y O/� �/ �I/C � P;fONE N0. ��L �? f� i <br /> i <br /> VALUP OF 470RK (do not incliade taxes) � � <br /> 5 <br /> (for commericol worki <br /> USE UP BUILDING _�, . �'j i d�.,�.�ri' s,+ / � <br /> NOTE: FIAC 296-46-140 reguires that plans for electrical work at educatzo7al, <br /> institutional or. health care facilitie�s be approved by the State f Washington. <br /> Applicants with such jobs must s.how the St:ate approved plar,a befoxe a City <br /> o` L•.verett permit n�i11 be issued. � <br /> i <br /> NOTE: Wiring in non dwellings is required to be in conduit. <br /> WORK TO BE DONE: ^ <br /> li�C/�.s-L'�.sy G �(,-S %��`�_��/-'/ .�i.c .b c��f2C �.!A i4 �� /L � S � <br /> J J �/� � . <br /> � <br /> f <br /> . <br /> SIGNED: � DATE: �� � - / � <br /> i{ <br /> i <br /> ! <br /> 3/27/90 <br />