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APPLICATiON FOR ELECTRICAL PERMIT <br />cin oF �at�r <br />BUILDING DIVISION <br />3200 CEDAR SiREET <br />EYERETT, MA 98201 <br />ii.e G/L�0//ES S/S� G�. iG /iLUD ivf���� lvN9S�d,3 � 6( J,`�,s'�-08FL <br />ner Mai ddress ty ta%te Zip '—�hone <br />s .o� E <br />eni ant — ai dress ity —State Iip o�e <br />SAn, F' <br />ectr ca ontractor a ress ity Cate ip one tate cense o. <br />��,+6� ' <br />ontract r ce o or roposed Use��uiTd ng <br />,Sisi a�Yi'+�' L .F�v.o <br />projcet Address <br />DiseripNon of Work Ta 6e Done: /,vc'�OL1 /t/Ew .Za�.O/NP SC•eU�G _F <br />NOTE: WAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL WORK AT EDUCATION�L, INSTITUTION�IL OR HEALTH CARE FACILITIES <br />BE APPROVED BY THE STATE OF WASHINGTON. APPLICANTS MITH SUCH JOBS MUST SHOW THE S"ATE APPROVED PLANS BEFORE A <br />CITY OF EVERETT PERMIT XILL BE ISSUED. , � <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO BE IN CONDUIT. <br />I HEREBY GERTIFY THAT I HAVE REAO ANO' EXAMINED THIS <br />APPLICATIUN AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND OFDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GNE <br />AUTHOHITY TO VIOUTE OR CANCEL THE PROVISIONS Of ANY <br />OTHER STATE OR IOCAI UW REGULATINC, CONSTRUCTION OR THE <br />P=_RFOFMANCE OF CONSTAUCTION. THAT I AM AUiH0912ED BY THE <br />OWNER OF TFIIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH Tt1E STATE <br />CONTRACTOI;S U1W i827 RCW AND 296.200 WAC. <br />X( /_1�.,� Y ;�it� ///���_ <br />� Signature Date <br />.���� <br />FEE �.� S <br />�-_ �28 7/% <br />