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�.,., <br /> r <br /> ;,..r. <br /> � � H <br /> m <br /> A � C <br /> b H tA <br /> y � � APPLICATiON FOR ELECTRICAL PERMIT <br /> .c n <br /> N p / <br /> � � r �/ _ � CITY OF EVER[TT <br /> T r _ UUILOING DIVISION <br /> p t� 3200 CmAR STRfET <br /> � H C EVCRCTT, MA 98201 <br /> C7 � � 2J�-881� � <br /> � � y �- ���p -� !,�//s o � 3�� ✓,�� �, �i r�,t,,.� ,� �i a.5'9 G'y3 7 <br /> O y Z r 1"' Mai ddress �ty ta:e�Lip hone <br /> R �..� lwner <br /> O N <br /> C C <br /> y p y �� � Mai ddress Cy tate ip Nhone <br /> enant <br /> ( k� ,��z.2� <br /> � �. ,��ul^ �/P���.� 3 yc�,C�aa � /�F✓/.��/� ,� <br /> ectn eal ontractor � ddress City , t te/ ip hone tare icense Ne. <br /> J/�I q/�f' �` i/ri,/Y _ <br /> l.ontract Price o N'ork �op6 d Use o ui�}�g <br /> V <br /> ? 3/l 1/�c�7� �, �� <br /> r�t Address <br /> Discription of Work To Be D�ne: � � ��n �ir 7 'hl�' � r <br /> ' .. 1 � �_ � �C P ��-P�� � T /l axt /•C � <br /> � '_ r;ll'r .SU� �6 riQ� �—� <br /> �� <br /> 1 <br /> I '��� <br /> ��� <br /> � �i NOiE: WAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL WOFN AT E�UCATIONAL, INSTITUTIONAL OR HEALTH CARE FAp LITIES <br /> �E APPROVED BY THE STATE UF WASHINGTON. APPLICANTS W1T4 SUCH J005 MUST SHOW THE STATE APPROVED PLANS BEFORE A <br /> CITY OF EVERETT PERMIT WILI DE ISSUED. ' <br /> + NOTE: WIRING IN NOIJ-�WELLINGS IS R[pUIRED TO �E IN CONDUIT. <br /> _,i_ <br /> ppPLRCAT ON AND KNOW THE SAME TO BE�TRUE AND CO AECT.ALl <br /> " ' s pqOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br /> �I I WOPK WILL BE COMPLETED WITH WIIETMEF SPECIFIeD HEREIN OR <br /> NOT. THE GRANTING OP A PEflMIT �GES NOT PRESUTAE TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> I OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION Ofl TME —� <br /> ''�'� PERFORM.ANCE OF CONSTRUC?ION.THAT I AM AUi�10FIZED BY THE � <br /> �� wI � OWNER OF THIS PHOPERTY TO PERFORM TNF WORK FOF WHICN FEE <br /> APPLICATION IS MA�E AND I COMPLY W�TH THE STATE <br /> ' CONTRAGTORS LAW 1827 flCW AND 296.200 WAC. <br /> X �,,�'�� �a 9�. <br /> ' Signature Date <br /> I���( J <br /> � <br />