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NOV/08/2017/WED 10: 30 AI�2 Gree ��od Hea,ting FAX No, 206 46�216 P, 001/01]1 <br /> EL�CTRICAL PERMIT APPLICATION <br /> C1TY OF EVERETT PERMfT S�RVIC�S <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> (P}425-257-88'i0 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> , <br /> , P�OJ��'T S�TE �NF�RMATION <br /> .. ........ . .... . . <br /> PROJECTADDRE88' �C2� FI.II�OCI ST <br /> 9UILDING Af2EA{if residential,new consfruction, remodel,or addition)��a0 3F <br /> BUILDtNG TYPE: JZI SFR-DETACHED ❑SFR-ATTACHEp ❑ DUPL�X l7 MULTI-FAMILY-#O�UNI75; ❑ COMMERCIAL <br /> use OF BU11D1NG: <br /> LfCT ICA�.APPLICATION INFORMATION . <br /> C�NTRACT PRICE OF WORK: 350.00 <br /> NUMBER OF DEVICES (if low yoltage : <br /> FIRE ALARIIR? ❑YES O <br /> ASSOCiATED BUILDiNG PERMIT# if a lica6le : <br /> DEscRi�TioN oF woRK: 20A/240V CIRCUIT TO MINI SPLIT AND 20A/120V CIRCUIT FOR GFCI <br /> CONTACT f1��ORMATION <br /> OWNER NAME:.JOSfI T@I7ltOEa T�NAN7 NAME(If Commsrcial): <br /> OWNER MAILING q�DRE3S: srREer �621 Fulton ST <br /> �„y Everett �TATE wa Z1� 98201 <br /> OWNER PHONE:.2O6�J79O9�L� pWlVER EMAIL: <br /> . ..,.. <br /> CONTRACTOR NAME:AS YoU WIS�I EE@Ctl"!C <br /> CONTRACTOR ADDR�SS: sTx�Er 825 S Stacy ST <br /> ��Seattle STA�wa Z,P 9813 <br /> co���qcTOR pkoNe: 206-783-2525 cor,TwacTOR�MA��; brendak@asyouwishelectric.c <br /> CONTRACTOR LIC.#(REqUIRED : aSyOU�/W92rjn1'1'1 CI7Y OF EVEF2ETT BUSIN�SS LIC_#�R�QUIRE ):Q 2 <br /> PRIMARY CONTAC'T: ❑OWNER �CONTRACTOR �OTHER(Pleasa S�eCify) <br /> CONTACT NAME: GONTACT PHONEc 2p6-783-2525 <br /> Brenda Keller car�TAcr EMA��:brendak@asyo�wishelec�ric.com <br /> AGREEMENT:I hereby cenify thet!heve reed end eXat771r7ed thls applJCaUon and kflow thb�Sama to be trtre end correct. A!I provis�ons oflaws gnU o/dinances goveming this type <br /> of work wil!be c�omp/e(ed whs(her speclNed herglq Or qpL 1'he gl'8nt/n�of�psY9flk doea not presume to givs eufhority fn vlaJatp ar CenCe!t�e prOvls/ons of eny other atate or <br /> loca/law regulating constructfon or[he perforrnance of consfrvctlon. That 1 am authorrzed by fhe owner ofthla umperty to peiform thQ work tor which applicar+on is msde and I <br /> cornply wkH tha Stats Contractors Law 18.27 RCWand 296.200 wAC. <br /> Clty of Everetf Ofliciel USe Only <br /> PERNIIT# <br /> � E 1� \ � ` O�� <br /> Own Agent 9lgnature Date (Rev�sed 9/23/2078) <br />