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�,PPLICATI� A� FOR ELECT�I�/�L f �R�a�' <br /> x C'7 <br /> [�]G7 <br /> >H <br /> ,a�x <br /> r�� �2VL't'2�� <br /> H z r+ BUILDING DEPAFlTMENT � <br /> '� y� 259�8810 � <br /> I '�_] rx-i� � <br /> CA H <br /> H t' <br /> � z� --- � ' - � � - -� ' - " <br /> OC+9 - ) :� � /�� ' /' 1/, <br /> HC7 ��bll .l _� �- [•Vl�� f-� � > >�-�'��� �i,' ;,- ll•t-i ri ' >honr . <br /> � �� wner Mai AdOress ty �p <br /> H C�]O <br /> �"�� � ai ddress ity cip hone <br /> H rndnt �I <br /> ay � - — �- -�i� L���1 ' <br /> � � �� hone icen5e 0 I <br /> r H y ectr ca lontractor Ma� Atlress �Cy �P � � <br /> O �� � .�('�� C� ��� <br /> ontract n ce o Wor ropaced ;e ol :d�n—g— <br /> � �� 7i b�' � r,r -�L � �— L�r � <br /> y O� ro�ece AtlOress <br /> Tc�-n -, �fJF��, _� �� jc,�_�� <br /> Ui:criptia o 'Nork o t3a Uone: <br /> �`�i <br /> +m <br /> 1�'�" ' <br /> t�' NOTE: WAC 296-46-140 REOUIRES TIIAT PLr1N5 FOR ELECTRICAL WORK AT EDUCATIGNAL, INSTITl1TI0NAL OR HEALTH CARE FACILITIES i <br /> BE APPROVED OY THE STATE OF WASIi1NGTON. APPLICANTS MITH SUCH J0�5 MUST ShIOH THE STA7'E APPftOVED PLANS �EFORE A <br /> CITY OF EVERETT PERM�T WILL BE ISSUE�. <br /> ��i NOTE: N:RING It1 ��ON-UWELLItICS IS REQUIREO TO OE IN IiETAL RACEWAYS. <br /> �� <br /> f�I� I HEPEDY CERTIFY THAT I HAVE READ AND E%AMINED THIS 4 <br /> i <br /> APPLICATION AND KNOW THE SA!dE TO BE TRUE AND CORRECT.ALL . <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS NPE OF ,' <br /> WORK WILL BE COIdPLETED WITH WHETHER SPECIPIED HEREIN OR � <br /> I' ' NOT. THE GRANTING OF A PERIAIT DOC-5 NOT PRESUME TO GIVE � <br /> AUTHORIT'! TU VIOLATE OR CANCEL THC- PROVISIONS OF ANY <br /> OTHER STATE ON LOCAI l.AW REGULATING CONSTRUCTION OR THE ,, [ � <br /> '��' OWNEOR'OFNTHI$PROPERTY TO PERFORM TrFIE WORKIFJq WH�CH FEE _?1 ��-� �� ( ' � <br /> �i APPLICATION IS IAADfl AND I COMPLY WITH THE STATE ' <br /> CONiFACTOR5 LAW 1827 RCW AND 296.200 WAC. <br /> . I. <br /> / / � <br /> X �/ / f�i� y ...(-����r � //��'�_1- <br /> oaea �/� ' � <br /> Signat�i re . �� <br /> , <br /> ym., ,� '_'_'1 ' '' �.p,"�7 _ _ ^"a.� �.�r-'" _ - ' ,s3'>. " ' <br /> - � _ . ...� .� � . �. <br /> � . , , '.'..' _ ' � . '.n �. .. _ -'- - - . � <br /> ' � .�y. _ ,� . ..v . ,..-. ., ... <br /> . . � .: . _ ! "'_ ' .. , e ° �� <br /> � <br />' y� f ,i.: s4� � » : I � . �ic,�.. .'4-:, "re;y,� . �. �.c iw..�r.�.' _ -<r...t . ' <br /> .. - ' .,. .. ..-��. <br /> , ._ ,. <br />._�tc�,.^. . .—�,.x. . P. . . .. �. ...-: .._. . . . «:.._. ,...:..,-...:. ...�.�._....� . . . . .. . �-- . <br />