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A.PPLICATION FOR ELECTRICAL• PERI�LIT <br /> CITY OF EVER.ET'i' " <br /> BUILDI.NG DMSION <br /> 32C0 C'cDAR STREEi <br /> EVE�ETT, WA 9820L <br /> 259-8870 <br /> Q� �Gf� Q(�J �� � �Q �`�� <br /> Qwner Mail dr-ss Ciry Staee/Zip Phone <br /> \ .�Z//(I� <br /> Tennnt �� Mail Address . . City State/Zip • Phone <br /> ��.�� �,�%/I,� ���5�/��57` �,�rf� �� �I�,�2�c�J�/l� <br /> , <br /> Electri C c or Mail Add�as City SL1[C/L:D ����,/� State License No. <br /> �� � � � s y <br /> Contract Price of Work Pro d Use o uilding <br /> �S'��o /l)��,��� _ <br /> Praject Address <br /> Descriotion of Work to Be Done: ��C v�/\� <br /> � �. <br /> � l���s -3 �3/ �.� �---_.z_ _._ _ <br /> ;IOT'c:1VAC 396-46-140 REOULRE� T'rL�\T PL.�YS rOR cLCTRICAL �'rOR� AT EDUCATION?.L, INSTINIIONAL OR <br /> HEALTH CJ.,'F FACII..ITIES BE APPROVED BY TEL STA'Ic Or �y'ASF�.*1GTO1J. APPLICANTS WITF3 SUCH IGBS <br /> h1UST SHOW Tf� STATE APPROVED PLANS BEr"ORE CITY OF EVER._.�"I' PERh1IT WII..L BE ISSUED. <br /> NOTE:WIRING W NON-D��✓E.LLINGS IS REQUIR.ED TO Bc L�! \tET�1LLIC R�CEIVAYS (MC AND AC, ARE CABLES. <br /> NOT RACEWAYS). <br /> I .�TEREBY CEP.TIFY TE�L4T I HAVE READ A,,tD EK.4.'•iLVED T.-s?S :L�PL?C:�7'10\ pND K,`JOW TFIE S,�ME TO BE TRUE <br /> AND CORRECI'. nLL PROVISIONS OF LAWS .WD OP.DL`7ANC�S GOVERDIING THIS TYPE OF WORK WII_L BE <br /> COMPLETED WITH WHETHER SPECIFIED I-�REi.'�I OR VOT. T^:= GR.liYTLtiG OF A PE?ZA1IT DOES NOT PRESUME <br /> TO GCVE AUTHORR�Y TO VIOLATE OR CANCEL THE PP.O�ISlONS OF ANY OTHER STATE OR LOCA[. LA��' <br /> REGUL.�ITTNG CONSTRUCTION OR THE PERFORhf,�,^1C� OF CONSTRUCI�ON. THAT I AM AU'1"EiORIZED BY TFLF <br /> OWNE� OF THI� PROPERTY TO PERFOR�t Tf-� �4'OR:� FOR `,1'3?ICH APPLICATION IS hfADE AND I COhfPLY WITI-: <br /> THE SI'ATE CONTRACTORS LAW 15.27 RCW ADlD 276.2CU 1VAC. <br /> .- <br /> Y '-"' /L�y�' G� ✓ . ��� � F���J <br /> Signature Dat� <br /> . ���0'� <br /> dttaPP r <br />