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� <br />r3 � <br />1� � <br />aG�", � N <br />aHx�n <br />H Z� <br />� H� <br />� �~/1 H <br />��� <br />ON <br />��g <br />�Y �] <br />t" y � <br />�yH <br />C] ly G <br />Qr <br />� <br />o� <br />v� <br />CITY OF EVERETT <br />ELECTRICAL WZRING FERMIT AFPLICATION <br />bB ADCRE55 _ <br />rNaNT __ <br />FRCF�TY OWrER _ <br />ELECTRiCAL CONTRACTOR <br />i""`� <br />DATc; 9�/�Cf <br />F� : <br />3 � _ iy � <br />1 �--,,,, �. <br />Y i c�-r..� �i,r� �� o� <br />ELEC. CONTRACTGR'S MAZLiNG A�CRESa �]O U� .�D ���� �U� r% IG���J �//� <br />LiCcNSE No. S T D s C� z I� I i2 � EXF?RA-iGN DATc /�. ��J <br />ACMZNI57RATCR �j �tie1/ �� � ��,p/�,�� pHONE tJ�. �p $ J-(� �/�/ <br />VALUc OF IYGRK (co not include taxes) <br />(ior commepcia_ workJ <br />USc CF 9UiLDING <br />NOTt: NAC 296-a6-140 reauires th�t plans � a- elect:ical �Nork at educational, <br />institutional or nealth cz:e �aczlities be aporoveC hy the State of <br />�� � Washinoton. Acplicants wiih such jobs rust show the State-approved plans <br />before a City of Ever��t permit will be �ssuea. <br />'�40RK TO ec DO�; <br />SiGNE� : � DATE � (Q d <br />NOTES AND CChN�1ENT : <br />,. , <br />; .,;!•. <br />- �.t <br />i�i" <br />,,",' <br />rfY <br />�. _, •=�: <br />:�; <br />�a�:-. <br />ss_'.',Gr; <br />�w:, <br />� 5 . . <br />�, �ri,� e �" u <br />r t <br />�',b'� �'� �'�+. <br />•;.�� (�,��$�iy �n <br />t1: <br />y:. h ; <br />. ��L .���� �. <br />� �'Y' ''i� ; <br />�µ{ � II ' <br />( i�'t�j� '� <br />:rt . , ,�,y . <br />:'A �_, f;.�,�.; <br />