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10/15/2009 10:06 4253778977 BOSCH ELECTRIC INC PAGE 02/02 <br />� � <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES /p-is -oq <br />3200 CEDAR STREET, EVERETT, WA 98201 C��O —D� (� <br />425-257-8810 - FAX 425-257-8857 — wvvw.evel'ettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CA12OS ARE NOT ACCEPTED <br />gl � �— D GuS'�" <br />PROJECT ADDRESS <br />�FI��4 d?IS IS� Sf ere.�i- QS�-ol �{Zs. 303. I�ZI <br />Owner MaliAddreSS Clty . SfaleJLp Phona <br />Tenant <br />Blectrical contractar <br />Mail Addrete <br />� QO � <br />n�l a,dd�� <br />ROscH-EZ�R3 Q-r <br />State License Number <br />Sf"-2 <br />praposed Use of Buiiding <br />DescripUon of Wofk to Be pone; <br />NOTE: WIRING IN NON-DWELLINGS IS REpUIRED TO <br />BE IN R,4CEWAYS, MC OR AC CABLE. <br />CITY OF EVERETI' LOCAL SAlEB TAX CODE 13 3105 <br />City <br />l,alr_e. <br />City <br />W lQ-lNG <br />StetUZip <br />W�� <br />State/Zp <br />l:ontract Prica of Work <br />Contad PerSon (Plen Review) <br />1 here6y certify that f have read and examined thls applicaBon and know the samo fo be hue end <br />cor�ecJ. All provisions allaws anU ordinances governing this type of work wrl! ps completed <br />whether specilied herein or not. The granHn,q of e parmd does not resume to give authorlry to <br />vlolQteorcencelrhe provlslonsofanyotherstefeorlocallawrogu%tingconstrudionorthe <br />penormance of canstNction. 7het / am euthorized by the owne� of this properry 10 perform the <br />work Ior whlch epplrcal/on is mede and I comply wifh ihe State ConUacto�s Law 18.2713CW and <br />296.200 WAC. <br />FEE <br />Phone <br />Phone <br />� Oq 10 - C�0 <br />