620 SE EVERETT MALL WAY SUITE 400 GYRO HOUSE 2017-01-13

EI�CTRICAL PERMIT AP�!CATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS: 6ZO SE EVeI'ett MaII Wa , Suite 400 BUILDING AREA (if residential, new construction, remodel, or addition) R@tl'IOCI@I SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: � COMMERCIAL USE OF BUILDING: ReStr"lUl'al�lt ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 5000 NUMBER OF DEVICES (if low voltage): � FIRE ALARM? ❑ YES 0 NO ASSOCIATED BUILDING PERMIT # (if applicable): �EscRiPriorv oF woRK: Repairing and replaceing existing 125A service CONTACT INFORMATION OWNER NAME: Ra�/a AIC�a�/SI TENANT NAME (If Commercial): G�/f0 HOUSe OWNER MAILING ADDRESS: srREET 11225 19th Ave SE, K106 ��,, Everett STATE V Va Z,P 98108 owNER PHONE: 425-595-8150 owNER EMAi�: raya.alqaysi@yahoo.com coNTwacroR NAnne: neigborhood Electric CONTRACTORADDRESS: sTaEET6605 200th St SW �,n Lynnwood STATE WA Z,P 98036 CONTRACTOR PHONE: 4Z�J-%%6-H� � 9 CONTRACTOR EMAIL: WSaf1CIaII�U aCtIV@@Clglll22f111g.11et CONTRACTOR LIC. #(REQUIRED): aC{�IV@ *O$St71S CITY OF EVERETT BUSINESS LIC. #(REQUIRED): OZ624H PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 2�6-683-�984 Wayne Sandall CONTACT EMAIL: AGREEMENT ! hereby certify that I have read and examined this applicafion and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be completed whether specified herein or not. The granting of a permit does noi presume to give authordy to vio/ate or cancel the provisions of any other sfate or /ocal /aw regulating construction or the performance of construction. Thaf I am authorrred by the owner of this property to perform the work for which application is made and I comply wrth fhe State Contractors Law 18.27 RCW and 296.200 WAC. Owner/Authorized Agent Signature City of Everett Official Use Only PERMIT # �� 7 /6 E �l� < < --d � � Date (Revised 923/2016)