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� n N <br /> rm � <br /> � � I <br /> y � � APPLICATION FOR ELECTRICAL PERMIT ! <br /> "0 u, '�° cin oF [v[R�rr � <br /> y 6UILDING DIVISION <br /> V�E O � 3200 CmAR STREET <br /> y <br /> � EYER[TT, MA 98201 <br /> � ;° 259-8810 <br /> H <br /> H -� �7 .� n <br /> ,H, y / {h'r� /"e /eh 5< r7 /S�7 /rvc .eh �vel"-e� i f� r/ .�5�,�^9�G2 <br /> 8 N Scr MaiTAdtlress ity tatc tip hone <br /> (1 O N <br /> � � r .SCP I <br /> � y enant ai ddress ty tatc p honc <br /> N <br /> ecET Crical ontr� ei ddress �ty—S[ate ip hone tate censo 0 <br /> L� // n <br /> J//�4/Y �-ri�i�f/ L- �'F S. <br /> ontract rice o Wor ropqs sc o�lluilding <br /> �vc�le r <br /> �je�ress <br /> � � � � /�'7�� <br /> Discription of Work To �e �one: �-t' {N/�"' Cr4 h4 4 'e ���� � �� /��G ��Q "� <br /> , _ / / r i �{ <br /> � ��. fo /�a� 4cfn 9 %-G / /o �jq /�f — <br /> � I'� -- <br /> __ <br /> i _ t�OTE: WAC 296-46-740 REOUIRES THAT PLANS FOR ELECiRICAL WORK AT EDUCATIONAL� INSTITUTIONAL OR HEALTH CARE FACILIT�ES <br /> i � BE APPROVED BY THE STATE OF WASHINGTON. APPLICANiS WITH SUCH J0�5 MUST SHOW THE STATE APPROVED PLANS BEFORE A <br /> CITY OF EVERETT PERMIT WILL BE ISSUED. <br /> NOTE: WIRING IN NON-DWELLINGS IS REOUIRED TO OE Itl COtlI)UIT. <br /> �� <br /> I HEREBY CERTIFY THAT I HAVE READ AND� EXAMINcD THIS <br /> APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECL ALl <br /> � PPOVISIONS OF LAWS AND OFDINANCES GOVERNING T}iIS NPE OF <br /> � �I� � WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED FIEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i . AUTHORITY TO VIOLATE OR CANCEL TNC- PROVISIONS OF ANY <br /> � OTHEF STATE OR LOCAI LAW REGULATING CONSTRUCTION OR 7HE � � �,-� <br /> ' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHO(iIZED BY THE <br /> 1�' AOpPLICAOTIONISISRMADE ANDPIRGOMPLY WIT�HKT ERSTATE FEE <br /> � CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> � <br /> X / i_-r-�-�-�+ <br /> i <br /> ' �gnature Date <br /> � '-( ��J � -� <br />