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APPLICATI�N FOR ELECTRICAL PERMIT <br />cm o <br />e� erett <br />BUI�DING DEPARTMENT <br />255 -8810 <br />�, <br />,l. )/i./�il� ( r�Q;19tC,� %" �/ 7.-��.:� ;�. .i : C✓[,�cl/ `.'fo:y �sr-�''9�/ <br />ner ail AEOress ty' �P nane <br />lenant e� O ress try �p none <br />i.ji y..` . _ <br />ectnca on[ra<tor a� ae�<ss �ty �p nonc icense k <br />�� G✓ G. /�' �j/-.t_ <br />cnVect r<e o Mor rapose .c o u �ng <br />i� � �, t <br />fOJlt[ OEfC55 <br />�s�:r p[ion o Wor o e one: <br />d•l- �lr ��i<�i � �i aF 4>> �i�� <br />—.%.G ��:. . «f�, i <br />NOTE: NAC i96-46-140 REOIIIFES TlIAT PLAHS FOR ELECTRICFL MORR Ai EDUCATIONFL� INS71TUiIG�IAL OR NEhL7H ChFE FACILIilES <br />�E APPPOVED BY Tf1E STAiE OP WFSIIINGiOtL APPLICANiS WITH SUCN J035 NO57 SI�OM THE SThiE APPfiOVED PLANS BEFOfiE A <br />LIiY OF EVEFEiT PERHIT wILL DE ISSOED. <br />NOiC: NIRIUG II! NON-DKELLINGS IS REOUIPE� TO �E Itl NC'�L RhCENAYS. <br />I HEREOY CERTIFV TH4T 1 HAVE REAO AND E%AIdIhGD iH15 <br />APPUGhTIOtI AND KIJOW THE SA1dE TO BE TRUE �N� CORRECT. ALL <br />PIiOVI510N$ OF LAYlS ANO OFOWANCES GOVEFNING THI$ TVPE OF <br />WORK WILL BE COMPIETED WITN WHETHER SPEQFlEO HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES IJOT PRESl1ME TO GIVE <br />Al1TMORITY TO VIOLA7E OR CANCEL TME PROVISIONS OF ANY <br />OTNER STATE OR LOCAL LAW iiEGULATING CONSTRl1CilON OR TNE <br />PERFOPMANCE UF LONSTR7CTION. TMAT I AM AUTHGRREU BV THE <br />OL4NER OF THIS PROPERTI' i0 PERFOR�A TME WORK FDR WHICH <br />APPI.ICATION IS MADE AND I COMPLV WITH THE STATE <br />LO(�TRAC70fl5lAW 1827 PCW AND 296.200 WAC. <br />/.. <br />/ <br />X�� •:�� � � � � � � �'�( �� <br />5iana[ure -� Datc <br />PEE -- � � <br />J � � � `� <br />