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CITY Or EVEREi'f <br />EtECTRICAL WIRING PERMIT APPLICATION <br />aoe aooR�ss <br />TENANT <br />PROPERTY OW�ER <br />DATc: �-� S � �� <br />FE�: � <br />��{ 1Z(�clC�.c /✓- �-e <br />_ �S i � VJ'1,�,�f s o ,eJ <br />S l97'Y,'� <br />ELECTRICAL CONTRACTOR � V- �(; L c��� IC <br />ELEC. CONTRACTGR' S MAILIN6 ADCRE=� _ I�1DU S �ti, ��J2 /l/(- /� �✓� y�{� <br />LiCENSE N0. �%��[(;"Z�(o J�Y/� EXF_RATi�N DATE L�C-/S <br />ADMINISTRATCR �� �G/�ne�G��-.� PHONE NO. �,S ?-�S�/�j _ <br />VALUE OF WORK �Q�}�."� (co not incluae taxes) <br />(f0i CORI(IIETc].0 w0ik <br />USE GF BUiLDING <br />NpTE: 'rVAC 296-46-140 reauir=s <br />institutional or health <br />Washinaton. Applicants <br />before a City of Everett <br />�ti'ORK TO BE DONE: <br />that plans ro: electrical •Nork at educationa'_, <br />care facilities be approveC by the State of <br />with such jobs �;.ust show the State-aoproved plans <br />perm?t will Ce =ssued. <br />SIGNED : �-��� � mz . �� DATE <br />NOTES AND COMMENTS. <br />