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�o e Paye`�o!6 2015�OB-04 05 20 18(GidTl 1988400036'. From pe�oran ";hieltls <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT. WA 98207 <br /> 425-257-8810 - FAX 425-257-8857 —www everettwa org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �4910 BLACK FOREST LANE <br /> i <br /> I PROJECT ADDRESS <br /> I <br /> ; LLOYD SMITH 49106LACKFORESTLANE Everett 98203 425-252-7544 ; <br /> � Owner Man Mtlress Ciry Std:e/1ip Pnnne , <br /> Tenant Meit a04ress Ciry State/ZiD P�one � <br /> WESCO 3909 196th St SW Lynnwood WA 98036 8D0398-4663 <br /> E�ectnCdl ContraCtor Pdaf�Atltlress Cify StatefZip Pnone <br /> WASHIES9710D ex 09/02/15 $600 <br /> State License Number Contran Pnce of Work <br /> SFR <br /> Pr000sed Use of Bud4lr.g Contact Person (Plan Rewewj <br /> � Descnppon of Work b Be Done: <br /> I ELEC FOR AC <br /> ��c-D���� � i <br /> NO fE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS. MC OR AC CABLE. },. �O ,OD <br /> �t <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> 1 hereby cenily fha�I have read and exam�ned fhis appbcatron and know the same to be hue and <br /> conect A!I provis�ons ol laws and orU�nances govemmglhrs fype o/work will be completed <br /> whefher SOen(ed here�n pr nof. 7h8 g�anfinq o!a pemri7 dces nofp resume fo give autnorrty fo <br /> violatc oi cancef fhe prows�ons ol any ofher staPe orlocal law regufating currsfrucHon o�the , <br /> work Ior wh ch appl/cel on�s made and!compry with I�e State Con(a�ctorsP aw 1F 27�RCW and <br /> 296 700 WAC <br /> ` /� Dlqila�lyvgn�tl try;enm�v.ovelb <br /> JQ�� I��r �O"/1IlO DMN=1PnNIe�CWellao-Northweitt'e�nnln� ou <br /> C 1 V C ertuil=�ennfop�nwpermrtmm.�-US � <br /> Da1e 7015 08.03]]:16:5�-0J'PJ' <br /> S�gnatum Date <br />