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Ar�LICA� ,JN FOR ELECTRICAL rERMiT <br /> cin or evmEn <br /> nu��uixc nivisioN <br /> 3200 CmAR STREET <br /> H Ct]�� _ EVOi[TT� MA 98201 <br /> � ta 259-8810 <br /> �y � <br /> 9HN �/�/lV� / �':��i✓ic'i✓ .� ti/.� �Lc. :��"�✓ � lliL' � .���j 'JL�S1. <br /> H � ner Mai AOdress � C��tate ip 'honc <br /> y �H <br /> K C] <br /> H� <br /> �H � enant Mai tldress ity tate ip hone <br /> f/�H <br /> �� �/ r <br /> L �' � - <br /> Qy d ectn cal on[ractor Mai�adtess — tty tate ip hone tate .icense o. <br /> �� Nq <br /> `�" on[ract rice o Work r po ed Usc cf �ui dinq <br /> xy� j/vt79� <br /> �N y ro�ect,qdtlress <br /> C]�[�/� T <br /> � � Discrip[ion of Work To Oe Donc: ��-/ �C" L' �}Lk./' J c"Y�v/��,, <br /> Oy <br /> ti <br /> � <br /> 1 <br /> I �� <br /> NOTE: WAC 296-46-140 REOUIRES THAT PU.NS FOR [LECTRICAL WORK AT EDUCATICNAL� INSTITUTIONAL OR HEALTH CARE FACILITI[S <br /> � OE APPROVEU BY ThfE STATE OF WASHINGTON. APPLICANTS WITH SUCf{ JOBS MUST SHOW THE STATE APPROVE� PLANS BEFORE A <br /> ' i ,_� ,CITY OF E\'ERETT PERMIi WILL BE ISSUED. <br /> � NOTE: WIRING IN NON-DWELLINGS �5 REOUIRED TO BE IN CONDUIT. <br /> I HEREBY CERTIFY THAT I NAVE READ AND� ERAMINED �i�H15 <br /> j �1 APPLICATION AND KNOW THE SAME TO BE TRl1E AN�CORflECL ALL <br /> PFiOV1510NS OF IAWS AND ORDINANCES GOVERNING 7HI5 7YPE OF <br /> WORK WILL BE COMPLETED WITH WNE7HEF SPECIFIED HEREIN OR <br /> _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF ANV <br /> , �� OTHER STATE OR LOCAL lAW REGUTATING CONSTRUCiION OR 7HE <br /> PEiiFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TNE �, — <br /> OWNER OF THIS PROPERTY TO FERFORM THE WORK FOR WHICH FE� J J <br /> �_ APPLICATION IS MADE ANO I COMPLY VdITH THE S7ATE — <br /> �� CONTRACTORS lAW 18.27 FCW AND 296200 WAC. <br /> / � ,- <br /> X �,�<<-�,.C. � /�L�L ���- .,�- /C - � ,� J� _ <br /> Signature Date <br />