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CITY OF EVERE7T <br />ELECTRICAL WIRING PERMIT APPLICATION <br />JOB ADD?ES5 <br />TENANT <br />PR(PERTY OWPER <br />ELECTRICAL CONTRF <br />DATE: _ r s,r r��/j� <br />Fcc: <br />/c <br />e1EC. CONTRACTOR'S MAILING ADDRE::, 1%SD_3 � 5,7�/i%� � h' �'� Y�'�� ,� <br />L:CENSE N0. >¢.EC"L _F �_�o � �- EXF_RA'i0N DATE /7��� F <br />ADMINISTRATQi �,.,L���,.� y, PHONE N0. ,����'"���� <br />VALUE OF WORK (Ca not incluae t�xes) <br />(for commercia work <br />US'c CF BUILDING <br />NOTE: WAC 296-46-140 reauires that plans for electrical work at educat.ional, <br />institutional or health care facilities be approveC by the State of <br />Washington. Applicants with such jobs �;,ust show the State-approved plans <br />before a City of Everett permit will be issued. <br />WGRK TO EE DO�: <br />�1 _��9 n � . <br />SIGNED : <br />NOTES ANR'COMMENTS: <br />r <br />DATE b'- ` <br />