Laserfiche WebLink
APPLICA�� �ON FQR ELECTRICAL r�ERMiT <br /> �� an or n2a�rr <br /> ISUIL➢IHG DIVISION <br /> 3200 CQ]AR STREET <br /> � � � 259-8810 � �'��. wn 9ezoi <br /> A � x < �. � ��HL� � � <br /> 9Ht~i� _ )iil/'c='i«/" ��1�0 �'� �7� ---� '� l,�-J �/'1 ^a�' �w'L � <br /> t•� - I" �..'�ir�'— - <br /> y �M �� Mai Address ty tate ip � Phone <br /> K C! <br /> H� <br /> O.'Z U enant <br /> yd p.�r{� Mai Address ty tatc i <br /> y�„� p hane <br /> �z� � lJICC /C :r."l-./�� /?�i>O �'�ii`rQtc=tir ;,,,�(,,ry�ll..�ls�G�3% ��l�i9�iJTAO[t'E=ro1'sJ�) <br /> O�,�, d ectrical ontractor Ma 1 AOaress ��ty State Zip hone [ate icense�— <br /> � �g <br /> 'n� �n^ on[ract Pricc of P'ork <br /> z H� C � Nroposed Use of Bvilding <br /> y ��`.�� �Yti f7PTST <br /> gyy Pro�ect ddress <br /> H <br /> a�y � <br /> a�e � DiSCNption of Work To Be Done: � _ �_ ]���%(�y�,] ���- ��r�,�� <br /> H O [n • -- <br /> � <br /> � <br /> I �� <br /> NOTE: WAC 296-46-140 REOUIRES THAT PLANS FOR ELECiRICAL WORK AT EDUCATIONAL, INSTITUTIONhL OR HE.4LTH CARE FACILITIES <br /> , BE APPROVED BY THE STATE OF WASHINGTOIJ. APPLICANTS WITH SUCH J0�5 NUST SIIOW THE STATE APPROVED PLANS BEFORE A <br /> � CITY OF EVERETT PERMIT WILL BE ISSUED. <br /> I � NOTE: WIRINC IN NON-DWELLINGS IS REOUIRED TO BE IN CONDUIT. <br /> � <br /> w_' I HEREBY CEPTIFY THAT I HAVE RF.AD AND� EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAN'S AND ORDINANCES GOVERNING THIS NPE OF <br /> WORK WILL BE COMPLETED WITH WHERiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � 1�1 AUTHORI7Y TO VIOIATE OA CANCEL THE PROVISIONS OF ANY <br /> OTNER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR 1}1E <br /> PERFORMANCE OF CONSTFUC710N.THAT I AM AU7HOR2E0 8Y THE <br /> � OWNER OF THIS PROPERN TO PERFOFM THE WORK FOFi YlHICH FEE <br /> _ APPLICATION I,i MAOE AND I COMPLY WITH THE STATE <br /> ' CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ��, <br /> X / J <br /> .� �� �/ � � . � � �� 1,��_c/� 7, <br /> � //��_,. :i:� <br /> Signaturc .� '� Oate <br /> ,,��ly`,� <br /> � <br />