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10/21/'2013 03: 15 4257780499 EWING ELECTRIC PAGE 02102
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<br /> ELECTRICAL PERIVIIT APPLICA'TION
<br /> CITY OF �V�RETT P�RMIT SERVICES
<br /> 3200 C�DAR STR�ET, EVER�TT, WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@�veretiwa.gov � www.everettwa.gov/permits
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<br /> PRo��c�ao�R�ss: 4632 Fawler Avenue, Everett, WA 98203
<br /> BUILDING ARFA if re5ldential, new COnstruction, remodel, or addltion)�A SF
<br /> BUILDING TYP�= ❑SFR-D�TACHED ❑SFR-AT7ACNED ❑DUPLEX m MULTI�FAMILY-#oF UNITS: �p ❑GOMM�RCIAL
<br /> U5E OF BUILDING: WOOC��'1aV21'1 ApBfttl"lerlt �iOCY1p�2X--�UI�C�ITIl�
<br /> �; ; ' ,. ,''<;�� ����i�lp�„ �� ;;r� ' �,,..;:.' `` .�;?� E4E�l."�RIG'"AL A�'P.L%ICATIdN I,hl�'ORMIf�A"1''�bN'; ; , " ,� ,
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<br /> CONTRACI'PRECE OF WORK: $ 150
<br /> NUMBER OF DEVtCES if low vOEta e :
<br /> FIRE ALARM? ❑YES �NO
<br /> ASSOCIAT�D �UILDING P�RM1T#(if a licable): NA
<br /> ��SCR�PT�oN oF WORK: Building L electrical room: Provide and instafl one (1) duplex receptacle
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<br /> CdNTACT,`::INFOE��VIATI�ON. ' ':. . , ,;�
<br /> OWNER NAME: TENANT NAME.(If COmmercial):
<br /> OWNER MAILING ADQRESS: sraeEr
<br /> ciTr STATH tia
<br /> OWN�R FHONE: OWNER EMA1L:
<br /> CONTRRCTOR NAML: EWII1g EIOGt�IC, inc.
<br /> cpNT�xc,cro�t ApoRess: STRE�r 539 M�in Street
<br /> �R., Edrn4nds srnre WA zia �g020
<br /> coNTRACTOt�pHON�: 425-778-3773 coNT�,cTOR�nno,i�: esorensen@ewin�electric.com
<br /> cat�rRacrot�uc.#cREQuiR��: �wingEl533BC CIIY OF EVERETT BUSINESS LIC.#REC�UIR�D): 4O3'64F
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<br /> PREMARY CONTACT: ❑OWNER I,�CONTRACTOR ❑OTHEft(Please 5pecify)
<br /> COPITACT NAME: CONTACT pHONE: 4��-]78-3773
<br /> �rik Sorensen cON'rACT ENIAII.: esorensen�ewingelectric.com
<br /> AGl2EEMENT.�f hereby certlfy fbat 1 havB rLad and exeminetl tA�s application and knoW fbe seme to be trt/e snd co+ipct. Ap prov7s7a�s oflaws afKi otd1nances gol�rning this type
<br /> of worfc wi�l be completed whefher spetUfed herern or not. Tl7e gR�nhhA of a pem7tt does nof presume to qlve&utborify to vfo!&te vf canc�l ttte provlsians of 8ny oYher stete or
<br /> locellaev regulaHnq const���Qn or tne pertormsnce of construction. That!am authanzed by fhe owner of fh�s property!o perform th�9 work for which applicatfon 1s mede anU 1
<br /> comply wi7/1 the Stsfe Contrac4ars Law 78,2P RCW and 29B.Zo0 WAC.
<br /> Cfry of Everetf OfHclaf Use anly
<br /> PEF:MIT#
<br /> rik Sorensen 11 .27.2017 E `� ���Z
<br /> owner/Author[zed Agent Slnnature Date (Revissd 9/23/101(3)
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