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I <br /> ' <br /> ! <br /> t <br /> I� APPLICAT�JN FOR ELECTRICAL r�ERMIT <br />� ! � � CITY OF EVFftETT <br /> I RUII.DING DIVISION <br /> i � 3200 CmAR STREET <br /> � � EYERETT� Mp 98201 <br /> ��� � � . <br /> �$9-88/Q <br />' �y �� , - , . .; �. <br /> rD DC �' , ' ,. � ., ./.i.-; . ' � ' . . � <br /> i . <br /> '�"s H U~i �f'/117i�' .i: .'/ >;• , . �i: .i <br /> I t,� nev�i r— Mai adress ity Ca2e/cip Phone <br />( , <br /> � " <br />� �y� ,.i��' � yvs� --.�.n��,rar,�,e /�ir� ��a�r� ��'? a��� <br />` �,�,p Tenant ai dtlress +ty tate ip D� hone <br /> I � V1M ' <br />� � �� l/JT ��i��iy �i rY�m< �1�'/� f3or��liu�. ��o .rdA_. 9�0/ <br /> � ectrica ontractor M ddj�Ss ity--�tate i� h�' one� tate icense o. <br /> C7 f'��'`��/f <br /> H t��l O ��� � /� .[G��//� <br /> nv n ontract rice o Work roposed e of�ui(aing <br /> y Aa�f�s� �rsdS' <br /> zH� <br /> � s ���a.�,rr�Y , r <br /> H y ro�ec A�9ress <br /> N <br /> H �/ /� <br /> nC� �iscription of Work To Be Donc: - ��7/C/��Q���G�I �// /�� _ <br /> �C9 � � <br /> � y SY <br /> � <br /> � _ -�;.�iu.»ds �r i" aG�3' i'o�z1�Ql'J�� <br /> � _ ,f'/ ,_f'��� <br /> C� <br /> NOTE: WAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STATE OF WASIiI�IGTO�. APPLICi,NTS WITH SUCH JOBS MUST SHOW THE STATE APPROVED PLANS BEFORE A <br /> • CITY OF EVERETT PERMIT WILL BE ISSUED. <br /> I �� NOTE: WIRINC IN NON-�WELLINGS IS REOUIRED TO BE IN CON�UIT. <br /> � �I� I HEREBV CERTIFY THAT I MAVE READ AND� EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECL ALL <br /> PfiOVISIONS OF lAWS AND Oi DINANCES GOVERNING TY.IS TYPE OF <br /> WORK WILL BE COMPLE7E0 NITH\VHETHEF SPECIFIE� HEREIII OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PPESUME TO GIVE <br /> ��I OTHER STATE OR LOCAI lAW REGULATING CONSOTRUCTION OR THE <br /> � PERFOfiMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE � <br /> OWNEfi OF THIS PROPE(iN TO PEPFORM THE WORK FOR WHICH FEE �D• O <br /> APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> '�� CONTRACTO(751AW 78.27 RCPd AND 29G'�00 WAC. <br /> X � '=�,�����.---� <br /> Signatur /� Oa[e <br />