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CITY OF EVERETT � r'-• DATE ID 'i`� � � � <br /> ELECTRICAL WIAING PF.RMIT APPLICATION FEE � �j�� <br /> ' JOB ADDRESS �� � I S/�E1/in/�i �✓�v� <br /> TENANT /1 /J <br /> PROPERTY OWNER �/ O � /`Q //N'� <br /> ELECTAICAL CONTRACTOR lC���Z�'7 S �'� %'/ L�J✓Cc.� <br /> ' � �.�. � ��� / <br /> CONTRACTOR'S ADDRESS � �O S �/�L'� � <br /> CITY ZIP <br /> LICENSE NO. /C�{'ZASS �.��5✓ ��'�' EXPSRATION DATE � I�/��/7 d <br /> ADMiNISTRATOR //�9�J '(/y/9�SS'� PHONE N0. � 7 7���'� S� . _ <br /> VALUE OF WORK (do not include taxes) <br /> (for commerical work) <br /> USE OF BUZLDING ���n/� Q <br /> NOTE: WAC 296-96-140 requires that plans for elec�rical work at educational, <br /> institutional or health care facilities be approved by the State of Washin3ton. <br /> Applicants with such jobs must show the State approved plans before a Cit}� <br /> of Everett permit will be issued. <br /> NOTE: Wiring in non dwellings� is requised to be in conduit. <br /> WORK TO BE DONE: <br /> aod ,�� ,— �:���%� <br /> SIGNED: � / " ���' DATE: �v ���� � � <br /> . 3/27/90 <br />