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� � � <br /> . . , � <br /> � <br /> .. � <br /> :. ; � <br /> -- . b <br /> CITY OF EVGRETT DATE � - ��9/ <br /> ELECTRICAL WIRING PERMIT APPLICATION FEE G�J J� , <br /> JOB ADDRESS J�i d 2 /�/-1 C 1"l �' <br /> TENANT _ <br /> PROPERTY OWNER K L IJ STA N hl E S S - <br /> x <br /> ELECTRICAL CONTRACTOR KXCLC E I EC772i f �j SEl2vlC�,j q� <br /> CONTRACTOR'S ADDRESS I 2.2 6'" � 3 � -S E R�'�+'F(( 9�SG/L _ <br /> CITY ZIP � <br /> LICErSE N0. ,`_'.XCtCES I'2,�C1I EXPIRATION DATE 2, 'GJ�L i�:� <br /> ADMINISTRATOR ��" �A PHONE N0. r]L/7_ - _�j`I7 <br /> VALUF. OF WORK (do not include taxes) <br /> (Eor cnmmerical work) <br /> USE OF BUILDING SlNG iF FN�'1 'h�''^� <br /> NOTE: S9AC 296-46-140 requires that plans for electrical work at educational, �� <br /> • institutional or heal�h care facilities be appro�•ed by the State of Washington. <br /> Applicants witi such job= must show the State approved plans beiore a City <br /> oE cverett per:n:t will be issued. <br /> NOTE: Wiring i❑ n�❑ d�xellings is requic�.d to ce in cond•ait. <br /> WORK TO BE DON�: <br /> C1-iANGt SE i� 1i�cE C h�lll�/�IENI � v�� v �= auti �Z 13�E.1letKl <br /> I6G/�. <br /> SIGNED: � � ��(�[.[.l�'�J� DATE: '� �� �� <br /> � <br />