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CITY OF EVERETT 2' DATE �' �]' CII <br /> �.. <br /> ELECTRICAL WIRING PERMIT APPLICATZON . . FEE ,��, (�(� <br /> JOB ADDRESS • _ I�I I�I �� r Q��1.�z ��� L ��PrP Lo� �$ <br /> �.�x . <br /> PROP£ATY'OWNER � � �,�u�„rrl,� � I-�me.s <br /> CT.F.CTRICAL CANTRACfOR l C>l i���4v� � `a r!r �'�ln)� <br /> CONTRACSOR'S ADDRE55 P . O. �[�X`�� `�`S' N' .IIL�r'�t� /��.JZ <br /> CITYS 2IP <br /> LICENSE NO. SCOUv1�IY� la(n I C -� EXPTRATION DATE � 5- � 1 - �J a <br /> ADMINiSTRATOR Y�� rQ G mS PHOtvE N0. 3,3�{ - �a I� <br /> � VALUE OF WORK (do not include taxes) <br /> (for =ommerical work) <br /> USE OF BUILDZNG S 1'2 <br /> NOTE: WAC 296-46-140 requires that plans for electrical crork at educational, <br /> institutional or health caze facilities.be approved by the State of Washington. <br /> Applicants with such jobs must show the State approved plans before a City ' <br /> of EWerett permit will be issued. <br /> NOTE: Wiring in non dwellinqs is required to be in conduit. <br /> WOAK TO BE DONE: <br /> . �E� L�p t�h I P_ _ <br /> u <br /> , - <br /> , SIGNED: �G� �p �Vl�.tn.�.., DATE: S'' �] '`I � <br /> 3/z�/yo � � <br /> rr <br />