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'��oro `� <br /> APPLICATIUN FOR ELECTRICAL PERMIT <br /> CITY OF �� <br /> BUILDINC DIYISION <br /> . 3200 CmAR SiREET <br /> 259-$81� E��7T, NA 98201 <br /> �CLEI r'` ,•�" �/l E�R Gr T/� PO�� �3 SY �c�F,PF C2J 9 � <br /> r.ner —-`�js�TJld r�ess— � <br /> Z� tatr. �`� �hone <br /> C� <br /> enant ai d ress <br /> �Y tate <br /> (°�P/llT�v r /�=rT / �Y°�Y-��'� CRf_ ?1'� <br /> c ec r ca ontractor � r 3� �fir .Fox .P.✓ �JT(JE�,L�n.�� G�.c� /( 8'�/(J <br /> ress ty tate/Zip rnone .�tate � cense o. <br /> ' �5�" 0�0 �� PoR r T� <br /> contraCt Prfce o or (�f��¢ <br /> ropose se o ui'lding � <br /> �S�� TF u �/ /� � <br /> ro ct ress <br /> )tscription of Mork To Be Done: �6L/�Q - /� � — _ ,s�/ ��� <br /> ./� / r <br /> --1�11/il ��/.ZQ(�.P S.cAJS.�t .P� /�fl i i/ / <br /> � i D� a��, ,��.J 1J.4. /r <br /> NOTE: NAC 296-46-140 REOUIRES THAT PLANS FOR ELECTRICAL WDRK AT EDUCATIONAL, INSTITUTIONAI. OR HEALTH CARE FACILITIES <br /> BE APPROVED BY THE STATE OF MASHINCTON. APPLICANTS MITH SUCH JOBS MUST SHOW THE ST�ITE APPROVED PLANS BEFORE A <br /> CITY OF EVERETT PERMIT MILL BE ISSUED. <br /> NOTE: XIRINC IN NON-DWELLINGS IS REOUIRED TO BE IN CONDUIT. " <br /> � HEREBY CERTIFY THAT I HAVE HE�� ANO' EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COFiRECT.ALL <br /> PqOVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF ' <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> NOT. THE GfiANTING OF A PERMIT DOES N07 PqESUME TO GIVE <br /> AUTHOAITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEFi STATE OR LOCAI UW REGUUTING CONSTHUCTION OR 7HE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERT' TO PERFORM THE WORK FOR WHICH FEE �/�,7 C)G <br /> APPIICATION IS MAOE .4ND I COMPLY WITH THE STATE — <br /> CONTRACTOfiS LAW 18.27 qCW AND 296.200 WAC. <br /> � / <br /> �a •-� 9�/- 9 z--- <br /> , ignatur � <br /> Date <br />