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� � <br /> APPLICATION rOR�L�CTRICAL P�R114IT <br /> CITY OF LVERETT � <br /> UUILDING DIVISION <br /> 3200 C[DAR STREET <br /> E•VERETI',WA 98201 <br /> 259•88f0 <br /> �N ��ti� i�y�-� ys��G, r�-F /�,�.�.,� l,Uu /�lJ3 <br /> O�mer Mail Address City SmldZip phone <br /> cSa-ozo5 <br /> (.U�C.� .�o.as.—,cu�r.o�v � <br /> Tenanl � bfail Address City StnldZip phooe <br /> C n � L.i�-Li35� <br /> G�i�E ��PeT.ci� /5/7o.t Siru�'ey Y'r .fJ/✓D /y1n�yS0�l��� �/itc-/t i3ad9 <br /> EI«tnnl Contractor D1nii Addrcss ity SmldZip hone Smte License No. <br /> Contract Pricc o(Work Froposed Uu o(IIuilding <br /> /f�1Y ��K �it �✓�x s� <br /> r�o�ui naa« <br /> Description of\VorA to De Dme: lX/'�"N/ YY/�`�+ Y�O—�¢_. <br /> �� / <br /> NOTE:WpC 296-0ti440 RGQUIRES 7'E�IAT PLANS FOR EL^^CTRICAL WORK AT EDUCATIONAL, INSTINf10NAL OR <br /> ]ILALTH CARE FACILITIES BE APPROVED DY TFIE STATE OF WASHINGTON. APPLICANTS WITH SUCH JOBS <br /> �tUST SHOW 7'F[E STA7'E APPROVED PLANS DGFORE CITY OF L•VERET PERMIT WILL BE ISSUED. <br /> hOT[:WIRING TN NON-DWELLINGS IS REQUIRED TO DE IN MEI'ALLIC RACEWAYS(MC AND AC, ARE CABLES, <br /> NOT RACEWAYS). <br /> 1 IIER6BY CERTIFY TEiAT f HAVE READ AND E%AMINED TH1S APPLICA7'ION AND KNOW THE SAT1E TO➢G TRUE <br /> AND CORRLCT. ALL FAOVISIONS OF LAWS AND ORDINANCE•S GOVERNING THIS TYPE OF WORK \VILL BE <br /> CO�fPLEI'ED\VITH \VHETHGR SPECIFIED HEREIN OR NOT.THE GRANTWG OF A PEItMIT DOES NOT PRESUDIE <br /> TO GIVE AUTHORITY TO VIOLA7'E OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW <br /> ILEGULATING CONSTRUCTION OR THE PERPORh1ANCE OF CONSTRUC170N. THAT I A�1 AUTHORIZED BY THE <br /> OR'NER OF THIS PROPERTY TO PERFORI.1 THE WORK FOR N'HICH APFUCATION IS DfADL•.WD I COMPLY WITH <br /> TIiG STATE CONTRACTOFS LAW I8.27 RCW AND 296.200 WAC. <br /> '` �%����o� 7'30�93 F� <br /> Signature Dale <br /> ������ <br /> a.<.rr O�sro» <br />