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qPPLICATIO���FOR ELECTRICAL P�.��1�T h <br /> arv cF <br /> =r� ev�re�t <br /> �>"3 gU�LDING DEPART�IENT <br /> C���-+ 359•8810 ' <br /> a H fn <br /> H �� <br /> o xo L/� �Lvl� �n.E'�l"/i.Qi/ � (� � /7��wo.:6C cY l �'P�O� -�o c� � y� <br /> '� N H Mai AdAress <br /> nOGf <br /> � O� �y �P hone <br /> HC enanc � Mai �ress < , L )/ �j! il"'! �i. ' ��� .��T/!LC. <br /> �N L%J� �'�` '`. • � <br /> �" hone tcense � <br /> � �C �LFZ�?f Sli� r/�-Z Ci 5 / <br /> O � ty , �P <br /> �� n c eatr�ca lontractor Mai Cdress <br /> x H 3 � ropase sc o ui ��9 <br /> � yz �ontract nce o Wor . <br /> H 1? � YI) ' <br /> y H �a�ect Atltlress <br /> g ��, <br /> ��r <br /> L�1 iscription a �yark o e one: <br /> y O f�/� � /J <br /> I c Y'/ Ui SG;F:.�r�t.��orc� <br /> fr'-G T .�c c� �,,.� .�-a � � .c' h <br /> � ' :f �r 7L � <br /> �/f � � i=��P.-�..�L�. ��,.. t.. <br /> %cc /� <br /> 1� � • <br /> � , INS7ITUTIONAL OR HEALTH CARE FACIUTIE <br /> NOTE: WAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL XORN AT EDUGTIONAI. <br /> BE APPftOVED BY THE STATE OF WASIi1NGTON. APFLIUNTS MIT11 SUCH JOBS MUST SHON THE SiA�E MPftOVED PLANS BEFORE A <br /> ',�� CI1Y OF EYERETT PERNIT NILL 8E ISSUED. <br /> �`a tIOTE: MIRING I11 NON-OWELLINGS IS REOUIftEO TO BE IN METAL RACEWAYS. <br /> a� I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> pPPLICATION AND KNOW THE SAME TO BE TPUE ANO CORRECT.AlL <br /> � � ppOViSIONS OF UWS AND OHOINPNCES GOVERNING THIS TYPE OF . <br /> `' ' NOT. THE GHANTOING OF AD ERMIT �OE ENOT PR'ESUFIE TO GIOVE <br /> AUTHORITV TO VIOLATE OF CINCEL THE PROVISIONS OF ANY <br /> � OTHER STATE Ofl IOCAL lAW REGULATING CONSI RUGTION OR THE ��; C ` <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> !'.� OWNEH OF THIS PROPERTY TO PERFORM THE W�RK FOR WHICH FEE <br /> CONiRACTO S LAW 1'0.27 RGW AND 96.200 WAG.�TH TME STATE <br /> !• � /� � �� <br /> X ,��Glt, .S=/f'�'�- �j(py <br /> ,�,�a„1�'C� L��,� <br /> Date <br /> ,_ SignaCure � <br /> f• " <br /> . � <br /> . ' '1 <br /> i <br />