Electrical Work Permit Application 1-9-04 001 Che,kone-W.;>0 COMMERCIAL !Lj ANNUAL PFRM"T ?RESIDENTIAL
ELECTRICAL WORK PERMIT APPLICATION
Please press hard-4th copy is posted # A55442
Today' date Instal lauon &,edpp
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Electrical contractor Ownet) clephonc number
kh wired by J
Address of inspection
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City oumy
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Yr// eF,ius owner a name
Lllwcafnunnacvor line I.iccuce numbs Please FkX'errecnonm inspection fee
41 /I / , - _ - s / - $ /
Purchaser's meillug address Becomes permit when properly validated.
i - Expires Pact 1) year from date of issue.
Fay Sate Ili Deparnnent of Labor ce Industries use only
o 1N9 / r
e„wersmnanv
I hereby certify that I atu the owner (unauthorized agent) of the above
named property or a licensed electrical contrsetur (or the firm's
authorized agent) and an making tire electrical installation Or alteration
io cumpliaance with the electrical law, e'hapter 19,2S RCW
~..'f'Charge my contractor's account.
Signawreet th,,-own. or aduuvarmm IJec~mJcal inspections are for safe airing niched, Inspections
tlo
X nutr,mbt V2K compliance
he, sen W. Pin, nn ,so., spetlor Omeo'lab xne
1 MALLS 2 CEILING 3 POOL 4 SERVICES
Insulation Only Insulation Only BondmgOnly Overhead
Dr, APFievu13v Date A~~qqt cd BY Dme Approved By Date Appro, cat try
[IUVer / ~ Y-S Awve, Yom, Equipment Only 1. nderground
Dar, A~,pmvw~By 7b/~- APpro^c,l 11v Uatc 4pprovdBy Date Approved By
5 SLAB b DII('11 7 FINAL "g TRANSFORMERS/
Covet Cover GENERATORS
Date Appm.cd By Date Approved By Doc Approved It, Date A,,,, ed By
9 FEEDERS/ 10 MOBILE HOME/R6" 11 SEE 12 OTHER
SUBPANELS service Only PROGRESSIVE
Date Annm.W By REPORT
Feeder OnIY
Date ApI'„vz,I B, Dam Approved Hv
Inspection
77 Date Area. Building, or Equipment Inspected keO M. Taken Approval No
~6 " L-^ Leal POST TINS "COPY ON JOBSITE.
1`500-001-000 electrical work pMnl.t apphcatiou r . 4-09 THIS IS YOUR PERMANENT RECORD.
JOB SITE