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CITY OF EVERETT DATE _ i � �� <br /> CLECTRICAL WIRING PERF7IT APPLICATION FEE 1---` � ` <br /> .;on ,w�Ress 'S�/ i� _S%��/�f —� % <br /> y �� TENANT <br /> � ^ / <br /> pi.9� � PROPERTY OWNER �"�� /Y � C. ��C�7� � <br /> t+ x� ELECTRZCAL CONTRACTOR v!'/ � ���� /'- L����' - <br /> H �M ,r�y� G' C�-� . <br /> Ky� CONTRACTOR'S AD�fiESS 5C�/(� ��D��/L/C �GC�' / t�GU� <br /> O x O CITY � ZIP <br /> � �ti H /' ] ` <br /> �„�� LICEN56 NO. �I � C.���J�'-y / / C�- CXPIRATION DATE � ' � .�� - � 5 <br /> � jy'd ADMINISTRATOR �:1 �i l�-'��CL. j�Q`'C'�/L�- PHONE t70. -� r'� - `��=�•� � <br /> ��g <br /> �� (7 VALUE UF WORK (do not include taxes) <br /> zy� (for commerical work) <br /> �N H U56 OF BUILDZNG � ��� <br /> N <br /> n❑d❑y NOTE: WAC 29G-46-140 requires that plans for elect.ical work at educaticn�l, <br /> Z Rl institutional or health care facilities be approved by the State of washinaton. <br /> o � <br /> xy Applicants with such jobs must show the State approved plans before a City <br /> y � y of Everett permit will be issued. <br /> � N!..E: Wiring in non dwellings is required to 6e in conduit. <br /> � <br /> I 4JORK TO BE DONE: <br /> C� ��� �, , .� � ''_%t�l. � ' ' � > i %1 <br /> 1 ' <br /> I �� <br /> � <br /> � '_1- <br /> I <br /> '=�`' SIGNED: '�/�,[/-G ,4 �/7 " � ! DATE: _ - / � " �� �� <br /> ��. _. <br /> r�. <br /> 3/27/90 <br />