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ELECTkICAL PERMIT APF `ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, tVERE.TT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� �j i f k. <br />� ?�� cJ ?� /��— �n, �.a <br />PROJE�T ADDRESS <br />, � ����,�;,�,�:��•C <br />„, <br />Owner <br />Tenant <br />�_I,��'�/: vrrl//;'! <br />Mail Address <br />Giry <br />Mail Addms� � � J-Yy A w City <br />� � � r /, h., r �m � ti <br />Electrical Con/tractor <br />Mail Address '� <br />�, ,..�{1 /T � �� �� ��� �7 — <br />State License Number <br />Proposed Use of Building <br />Description of Work to Be Done: <br />.. ii.�Y�L/ <br />Cily <br />State/Zip <br />State2ip <br />B'.� 73 � l �' <br />State/Zip <br />Contract Price of Work <br />Conlact Person (Plan Revie�v) <br />O %?'7 Y, _ <br />Phone <br />Phono <br />Ph5 one <br />NOTE: PLANS FOR ELECTRICAL WORK AT EDUCATIONAL, FACILITIES UTILIZING STATE FUNDS MUST EiE <br />APPROVED PLANSEBEFORE �C TYJ OF E ERETT PERM TAW ILL BIEHSSUED. J WACM 96 46-H OW ALL OTHER <br />EDUCATIONAL FACILITIES AND ALL HEALTH CARE FACILITIES PLANS WILL BE REVIEWED BY THIS OFFICE. <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO BE IN RACEWAYS, MC OR AC CABLE. <br />HANDICAPPED ACCESSIBILITY: ELECTRICAL AND COMMUNICATIONS SYSTEM RECEPTACLES ON WALLS <br />OF 5I NCHESSABO E THE FLOOR.AWAC 5120 SEC 3 106(�2T[S OF TRAVEL SHALL BE MOUNTED A MINIMUh4 <br />ENVIRONMENTAL AND OTHER CONTROL RECEPTACLES AND OTHER OPERABLE EQUIPMENT WITHIN <br />RANGEB OF WAC 5E 20 SEC.�N05(b)4CE & FI AND N�OTTL SS THAN 36LINCHES ABOV�E THE �LOOR.�N THE FiEACH <br />I HEREBI' CEFTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATIOIJ AND KNOW TNE SAME TO BE TRUE ANC CORRECL ALL <br />�CT,VTH'�GRA�NTING OF A PEAM�7' DOES NO �PRcSUME TO Gll/E A�HORITY TO'VIOLA7EOOR CANCE � Ht PROVISION'S OF ANY OTH�R <br />y:�NER OF�HIS PROPERTYATO PERFOR�U7HE�WORKrFORFWH�HA PPLICATI�ONSSpMADE AND ACOMPLYUN��H'THEBSTATE <br />CON7F.7CTOFS LAW 7H?7 RCW AND 296.200 WAC. <br />,� <br />.-�/ <br />— � - `� ' Date <br />Slgnature <br />DEBIT & CREDIT CARDS ARE �OT ACCEPTED <br />FEE <br />