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� <br /> 4 <br /> i <br /> , <br /> APPLICAT uN FOR ELEC�'RICAL NERMIT j <br /> ,o�x —/ cin oF evea�r I <br /> H <br /> �� DUILDINC DIVISION <br /> YHlA �'��� � _ EVEBEfT�AMAS982Ci � <br /> � <br /> r % <br /> H a �� � �: � .:,,.� , ,��" �,�� , �-•��. _ �! ' — ' , <br /> � � H� 259-88f0 U�!'/�� ��// _ �l` <br /> � �H Chr��f-P�i.SPn flovlr5 �yZI n�lc,��,,e Uc�•c� 17. /Ylul� �I} Pv� �,J� �/ kL7Sl 3S�G6S'� <br /> y ,.�� ner N.a�l Ad ress lity Sta�e ip Phone iI <br /> � O� I <br /> H <br /> OH <br /> H �g enant Mail tldress ity tate ip hone � <br /> 4']a O � <br /> , � � ,��� 1' , �. ` z) �5 Y� S <br /> � y� S, s l�v�� e t/r�� 9�a�s�. il'r���i�� ,�if y� � -y� r Z"Ds«-iz�a��� <br /> x ectn cal ontractor Mai Address ity S�_� ip �ione tate tcense o. <br /> r-+H <br /> �' S r� <br /> H <br /> � �� ontract rice o Work Propor— .cd Use o� Building <br /> � o� 50���a��� lrJ L'uc��-c�l�- _ <br /> roP ject tldress . <br /> Diseription of Work To Be Donc: `C�� A /'� �P� � f U� <br /> .,. <br /> �� <br /> �' — <br /> NOT£: WAC 296-46-140 RE6'IIRE� (HhT PIp.:JS FOR ELECTRICAL WORK AT EDUCATIONAL, INSTITUTIONAL OR HEALTH CARE FACILITIES <br /> �� BE APPROVED BY THE _`�ATE OF ti:.SHINGTON. APPLICANTS WITH SUCH JOBS MUST SHO'n' THE STATE APPROVED PLANS BEFORE A <br /> _ ,CITY OF EVERETT PERMIT WILL �E ISSUED. <br /> NOTE: W�RING IN NON-DWELLINGS IS REOUIRED TO BE IN CONDUIT. <br /> �'� <br /> � <br /> I f�EREBY CEf1TIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPUCATION AND KNOW THE SAME TO BE TRUE AND COFflECT.,\LL <br /> PFOVISIONS OF IAWS AND OflDIN.4NCE5 GOVEFNING THIS NPE OF <br /> �'� WORK WILL BE COMPLETED WITH WHEfNER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> � AUTHOFITY TO VIOLATE OR CANCEL THE PflOVISIONS Of ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTflUCTION Ofl THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE �j <br /> �'� OWNEfl OF THIS PROPERN TO PERFORM THE WOFK FOR YlHICH FEE J <br /> APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> - • CONTRAGTORS LAW 18.27 RCW AND 296.200 WAC. <br /> X �'7 <br /> _ �i �,� ��,'�<-�% CJ_ �/'� � <br /> �, , /, � / � �� <br /> Signature <br /> � oat� <br /> � � . <br /> � . ', <br /> �,_... � <br />