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I , <br /> A(�PLICATI�,�V FOR ELECTRlCAL 1 =RMIT <br /> CITY OF <br /> �ver�tt <br /> BUILDING DEPART�b1ED1(' <br /> 259-A810 <br /> � �A�,�� � <br /> ( � �rn��%"l �.l(� I � .�,�A���� r V �. " �,.. <br /> O�rner ' � :�I �<CI .�o �� ., . <br /> 11ai1 Address '�� � �:�� 'L- �L-tr� � � � ��-1 �. � <br /> �YS �P^ 'hone — <br /> enan[ '� � � f"' �l'G L _i_Cf_� �- `Y�%-v� <br /> lail tldress �tY <br /> cctrica lontractor Mai tldress <br /> Li[y ip hone <br /> icr.nse A <br /> Iclk A � �l=Clk��' TuC 1�C� 1'�� �t ( U7� �� , <br /> antrace nce o wor � - �'���� '�`'�'� � � �r /% !1`.(J{� 3�'� � \ �U� kL T (�i � <br /> ,� roposed U e ot � ���9 <br /> '� tr� . i � .�) <br /> �' o ct Address � � �� -�/' .. . �, Y - �-�� �, <br /> i <br /> , � <br /> ��I �lf.��„L � � �� l l 1 C��� �- � - <br /> Di cn ption or Nork o L� Uone. � <br /> _ �� �C(_11t� � 1� :�r �� <br /> `� �c� 1�1- 1\ 1 �-�- �� � <br /> NOTE: WAC 29G-4G-140 REpUIRES THAT PLANS fOR ELECTRICAL WORK AT EDUCM IONAL, INSTIiUT10NqL OR HEAITH CARE FACILITIES <br /> �E APPROVED BY THE STATE OF WA3HINCTON, APp�IG1NT5 WITfI SUCH JOdS MUSi SHGiI TIIE STATE AppROVCD pI,ANS �EFURE d <br /> CIT'i 0� EVERETT PERMIT WILL 8E ISSUEO. <br /> tIpTE: WIRING III tl0�1-p'NFLLI11f:5 IS REOUIRED TO IlF IN 11ETAL RACEMAYS. <br /> I HEFiE�Y CERTIPY THAT 1 HAVE READ AND FYA�dINED THIS <br /> APPLICATION AND KNOW THE SAId[ i0 t7[ 7RUE ANU CORRECL ALL <br /> Pf70VISIONS OI'IAWS i+ND ORDINANCES GOVERNING iHIS TYPF OP <br /> WOAK WILL�E CCMPIETEG WiTH WHETHER SPEGFIC-D 4EREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[ <br /> AUTNOf/1TY TO VIOLATE O(i CANCEL THE PROVISIONS OF ANY <br /> OTHEfl STATE Oq LOCAL LAW flEGULATWG CONSTRUCTiON OR THE <br /> PERFOHMANCE OF CONSTqUCT10N. THAT I Ald AUiIIORIZED BY THE <br /> OWNEfl pF THIS PROPEFTY TO PERFOFlM1f THE WOF�K FOR WHIC11 -�I - <br /> APPLICATION IS IAADE ANO I COMPLY WITH TNE STAT[ r« �� � �' � � <br /> CONTRACTORS L�Y�10.27 RCW AN�29G.200 WAC. <br /> X �� ����'��'-' t/ ��. . �'.< L, . �.. � <br /> Signatura ���, — <br /> / <br /> � / <br />