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.� <br /> e �r <br /> � <br /> � �RPLICAY�N FOR ELECTRICAL i RMIT <br /> � ritv ar <br /> �� everett <br /> BUILDIPIG DEPAFTtitENT <br /> 259-8810 <br /> ; � <br /> H �� � <br /> H �M -}— <br /> O HO V/MMY .ZAh�'R � 71� ilL'l.ip� r..taa.�.11 �.�'i) J ��`/-.�-Y.L`{ ( <br /> �d �;� newlS r ai ddres�s--��ty �p hone <br /> h�. (p M . <br /> RI�i� enant ai tl rev � ti y Zip--l�honc <br /> w �C �)CF_ Neo.� S� n� s /1J�2 '`�N�'f5f Fu.�c��i S�cP3c+Y a9� ��fi� 3 <br /> �Aty ectnca �ontroctor ai J rese � ty �p honn cenae <br /> t}a a <br /> a. ci <br /> � M ontrac� n ee o ' or roposeJ se ot u J�nq <br /> ,�,� y C�DU � <br /> M �ro)eU EOress <br /> �� scr ptian of 'Nnrk o� �q1 � F �3�/�✓% � n <br /> y� �1)/ �f' lJr.e�. — u'p 6'oul�/2 .ti. �K/d V��a*u�� <br /> 6�A <br /> NOTE: WAC 296-n6-140 REOUIRES THAT PLVIS FOR ELECTRICAL MORK AT EDUCATIUNAL� INS�iTItIIONnL OR 11EALiH CARE FACILITIES <br /> ��,� DE APPROVEO BY THE STATE OF M�SIIINf,T011. APPLICANiS MITH SUCH J005 MUST SIIOM IIIE SiATE �P^P,OVEO PLANS OEFORE A <br /> CITY OF EVEfiETT PEflMIT NILL [fE ISSUED. <br /> � <br /> NOIE: �IRIIIG IN 11011-DWELLIqGS IS REOUIfl[U TO �E IN METAI R�CEWAYS. � <br /> �' � <br /> �+ ^ I <br /> I HEREOV CERTIFY THAT 1 HAVC qEAO ANU E%AMINE� THIS <br /> APPLICATION AND KNOW THE 5�ME TO BE TRUE AND CORRECL ALl <br /> PROVISIONS OF LAWS AND OR01"4NCE5 GOVEPNING IHI$T/PE OF <br /> �� WORK WILL 6E COMPLEiED W,�M WHETHER SPECIFIED NEREIN OR I <br /> NOT.THE GAANTING OF A 7ERIAIT OOES NOT PRESUME TO GIVE <br /> � AUT`+ORITV TO VIOUTE OR CANCEI THE PROVISIONS OF ANV <br /> OiHel;STATE OH LOCAI LAY�REGULATING CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONSiRUCiION.THAT I AM AUTHOf112ED BY THE � ��,_ � <br /> � OWNEfl OF TIil3 PROPERTY TO PERFORM THE WOI7K FOR WHICH FEE <br /> APPLICATION IS MAOE AND 1 COMPIY WITH THE STATE -- <br /> CONTRACTOAS LAW 10.27 pCW ANO 29G.200 WAC. ' <br /> !, ' <br /> x , -� �`�.."w. �J��i�L h3 <br /> _'� Sfgi ure Date ^/7 . <br /> � �v <br /> � <br /> � — <br /> I <br /> I <br /> � <br />