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..' ,, .l V � � <br /> � '!l[CTRICAL tlCTON ^� <br /> j OEPARTMENT.DF LABOR AND INDU9TRIES F APPLICATION FOR ELECTRICAL <br /> �, •y` � INSTALLATION RF.VENUE STAMP3 <br /> -- =�-=----_= g ������.� ��,�� <br /> -'—_----__-_— �nl� ��h WMnf �+MI. !'len� In�le�b n�m�rt sf I�oN� nttllH� --- I10111lONOOf �� <br /> NOYCG: kac� ld ItVutru� wV '" _"_.'—" <br /> __.__.�._.�..�_.—.�-.._ ...—_�- Il�'oMrr�ri <br /> IPk.0 Pnml ' —L.laiw R • <br /> ��.me o� fvnk Continental Inc. �— ,z;. <br /> ^--� Mnr�r �� <br /> iM.�uv i,n.� Ldmonds, Wflt3h1i1gb�II �°�'�` <br /> ��m..,r 23607 Highw4Y �I �--- � <br /> ,,;,,;.���„M AJJm�o� JajpeB a 25z- 455 <br /> u,,,�,�,�.�,,�.�M�� / 1131 (irdnd Ave. EWerett, Wash. Own�r: <br /> n� tot- <br /> Affidavit of Home Owner's Sate Wiring I.abel <br /> stullnlonelbi�c�mD��n��tK'��h RCW lr�.^-B�Bkctrlclonstand9E�eclrcallnslallaUotuhLew.tlon I proDose to m�ka �n eiectrlul In- <br /> sl[n+�ure <br /> 11eq�OR11C! <br /> Revenuc Stamps ISSIICtI <br /> ''�O' Amaunt <br /> SlnmP SlamD � So1E <br /> Amounb Scrlm So1d <br /> . � .._.. . .........__.........__.. <br /> thru — _. ....... ._ <br /> _. . — <br /> � .�G No. .. ......... . ._ _._ . ........._..... <br /> — ....... .�.......... . . <br /> _ . thru _.. . __... — . <br /> 1.00 No.................................... . _._....__.... <br /> .... ............... thru — _ _ ....... <br /> � <br /> 3.00 No. <br /> _..... . _.__.._.... . .. <br /> thru = _.. <br /> 4.00 Iv o. _ . . . .... <br /> ___... <br /> . <br /> _ .. . ... . <br /> _. .......... ....... ..... .__ . thru ... . ...... _. <br /> _ .. ....... <br /> 7.00 No. _........__.... <br /> thru — ............._............_.._ <br /> 10.00 No..... .........................._......_.........._...... — <br /> .........._........... ................... <br /> _......._......................_..._.... .._ ......__............._..._......... ...._..__............ <br /> _. thru ......._........._......._................._. — .. . .._......_...._................................ <br /> — <br /> 12.00 No._......_._................_......_......_. .. . ...._......_............... <br /> _ ....�......_................. ....> <br /> ......... thru _........................................................ — ..._...,.................................._......... <br /> 1G.00 No. . _ . ........................... _ ......._..........._........ ..........._�...........__........._._..._..___._.._. <br /> ....... thru — ............_._.......... <br /> '10.00 No... ....._..........._..................._. ....................................... <br /> _ _._.__....._...._.__. ............._____._...._ <br /> _.._..... thru ........ — ........._. <br /> ......................................... <br /> 100.0U No. . _........_ ................. <br /> _............................ <br /> + $..........._..._.._. ........__-__._—__- <br /> TOTAL Revenue Stamps ................. ....._.... ._.............__... i���4.w <br /> [] Chcck��.OTE! I�SAhE A T7iTTA"7CF PAYAHLE TO IILPABtYLN7 OF LABOR AND INO11871tI6! NOTE!� <br /> p Cash <br /> NOTE: Safe wlrin[ �abcl muat be compleltlr ���d Iet1611 fllled out. Each installntion mu�t be aPD*a����On service conneetlon+ <br /> arc madc by thc scrving agency. <br /> Aflla revenue slamps to back side of labei seclion number 2 and mail or dcliver <br /> to Eleclrfenl inspeclor fcr the nrm ahere the electriril Instnllntlnn has been made. <br /> Relurn aPP���t��on ire-+tu4���m x•Ilh the Indical�d fc�s lo lhe nearc�t dl�trltt olflee. <br /> NOTICF. OF PF.A'ALTY <br /> A fcc of $11.00 per hour or frncl+.'on thereot shall Ue paid prior l� approval ot thc installation for the <br /> {,���a•.��ng inspector scrviccs. <br /> t. Unneccssary trip or trips to inspect when ]abel huldcr has gi�'en premature notice to the inspec or <br /> t�ia; thc work is rcady tor inspection when it is not or has �iven an erroncous address, su6ject <br /> to approval of the Chie[ Elech•ical Inspectnr or Assistant Chief Electrical Inspectors or appcal <br /> from thcir decision to thc Ad��isory Iioard. <br /> � Ptemature Inspection <br /> [t Erroneous Address <br /> 13. More than one additiunal inspcction cnll per 1aUcl ���,���nr lnckCot,kno�wledge of lhe cod ontthe <br /> naticc ot the inspector, ns n resull of CBfI`If55I1C5S, OC�; <br /> parl of the laUel holder or his employces, subjcct lo +�pPr�"'°� °f �hc Chict Electricnl or Asslslant <br /> Chic( Electircal Inspecters or appenl trom lhcir decision to the Advisory F�oflrd. <br /> I navo rcatl penNty N:mae�nd�cknowledRe ume. <br /> . .:_'3` > <br /> ;. <br /> ii-a..0 ARI.11'ATIO\ roMn.��ctu�c.i.��er.�i .i,�.. .�..�:wm. sn.�rsn �. <br />