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APPLICATION FOR ELECTRICAL PERMIT ,�� i� � <br /> Cf�(Y OF EVERETT <br /> BUILDINC D�VISION <br /> 3200 CFDIIR STREET <br /> • EVERETT, MA 98201 <br /> 259-8810 <br /> _�lo��Gzz{�- I��y�o ,C�� P�' ,�CI f�tl�e�v� �.,X� Q�$ ys�-3��r <br /> � e� ' Mail Address ity tate p one <br /> ena�t ai ress <br /> . ty tate p one <br /> 7�D[-�IL ,!�' 13�t�o a��A�,+�.� ei.�/�d�,r�f�°a3ri8-�o�9�i3 7.�0�o�8�a <br /> ectr ca ontractor a ress ity�tate p one tate cense o. �G� 1 <br /> • S� � <br /> � ontract r ce o or ropose se o u ng <br /> �19 P�� v��� - � �� a� <br /> Rro3ect Addross / n� roo� �� L`�'�� <br /> C� <br /> Diacription of Work To Be Done: N�� /y�(JS� � � p.0 U �Yr��O <br /> NOTE: WAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STATE OF NASHINGTON. APPLICANTS MITH SUCH JOBS MUST SHOW THE STATE APPROVED PLANS BEFORE A <br /> .CITY OF EVERETT PENl11T MILL BE ISSUED. � <br /> NOTE: MIRING IN NON-DMELLINCS IS REOUIRED TO BE IN CONDUIT. <br /> I HEREBY CERTIFY THAT I HAVE READ ANO' EXAMINED THIS <br /> APPIICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br /> WOHK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN OR <br /> NOT. THE GFiANTIN� OF A PEFiMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFITY TO VIOUTE Ofi CANCEL THE PROVIS�ONS OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE ,���p0 <br /> OWNEA OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> X <br /> �-r .li�� ��� /.2,3O'9Z. <br /> Signature Date <br />