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03/02/2007 10:00 4253778977 BOSCH ELECTRIC INC PAGE 02/02 <br />( <br />�i��l"1�1��,�. ���tlllil�' �PPLI�/�l'E�iV <br />�tTY OF EiIEFt�:"�"i R�ERII�IT SI�RVIC�S 3��-o� <br />3200 CEDAR S� REET, EVERElT, WA 9Fi201 <br />425-2�7-8810 - FAX 425-257-6857 — www.evereitwa.org � 0703�-DO� <br />APPL1GAilOFIS A�E ACCEPTED FR�3M II AfJ! FO k Ph9 - bE61T $ CREI)IT CARDS Ai2E NOT iNCCEPTFQ <br />'133 �71►�� <br />PROJECT AUDRESS <br />�_ �7� i5 i5�'�' -� - Cuere�� L�;A �Szo� -�z5, 3v3 ��zl <br />Owner Mail Addre,s :it/ Siel�2ip phone <br />Teaanl <br />Mail Adtlre ,s <br />Conlractor Mail Address <br />l305Crf,�.Sq��3Qi <br />Stale License Numbet ` <br />Jrl� <br />Proposed U,e oF 8uildinq �—'^� �� <br />DeScriptipn of JVork lv 6a Dune: <br />NOTE: WIFING IN NOM-DWELLINGS IS REQUIRED TO <br />BE IN FACEWP.YS', MC OR AC CABLE. <br />CI iY OF E4ERETi I.00AL SALES TA?( CODE IS 3105 <br />! tierzby cedily (bat / have re�id <br />cor�ec(. All provislons of l:iws a <br />whotherspeclfied h,erein o�not. <br />violafe or cance/ the provls;ons <br />pedonnsnco of construcfion. 7� <br />tvork for wltich apP�icafinn Is m:, <br />296.200 WAQ <br />ezamined this <br />s <br />Glty <br />Ciry <br />:afron and kno�v fhe se <br />� ihls typc o/ work wi7/ � <br />t dces no( pr:.+sume to <br />1 faw regula(ing consti <br />° owner of �hrs propen <br />Stato Cenhocta�o Ln� <br />3-/07 <br />Stater_•ip <br />/V�-�i <br />9lale/Zip <br />Gontract Pnce of WorR <br />Conl3ct Perso� (Pian Review) <br />to be fnre and <br />�mpleled <br />� au�horrtv to <br />and <br />f-EE <br />PhOne <br />Ptrone <br />