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03/03/2018 09:30 FAX 425 377 1976 REX ELECTRIC [�001 <br /> EL�CTRICAL PER�VIlT ,A►P�ICATION <br /> C1TY OF EVERETT PERMIT SERVIC�S <br /> 32Q0 CEDAR STRE�T, �V�RETT, WA 98201 <br /> (P) 425-257-8810 � �AX 425-257-8857 � (E} everetteps@everettwa.gov � www.everet#wa.gov/permits <br /> PROJECT SiTE 1NFORMATION <br /> Pf20JECT ADDRESS: Q � � <br /> BUiLDiNG AREA(if residential, new construction,remodel,or addition) S� <br /> BUILDING TYPE: �SFR-�ETACHED ❑SFR-ATTACNED � DUPLEX Q MULTI-FAM(LY-#OF UN(TS: COMMEftClAL <br /> USE OF BUfLDING: jj�,� ' � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ V -� <br /> NUMBER OF DEVICES (if iow volta e): <br /> FIRE ALARM� C!YES NO <br /> ASSOClATED BUIL.DING PERMIT# if a piicable): <br /> �ESCRiPTtON OF WORK: ' ' <br /> O� � o <br /> CONTACT lN�ORMATION <br /> . P . . . . . . . . .. . <br /> OWNER NAME: ;G. ��r 7ENANT NAME(tf Commercial): <br /> OWNER MAILING ADDRESS: srr�_�cr � i ,��m <br /> ci��v sr�,r� �� �� <br /> 01NNER PHONE: � �� '��� � E �7 OWNER EMAIL:�d�GI� ° <br /> CONTRACTOR ADDF2ES5: 11712 18th ST NE <br /> Lake Stevens WA 98258 S7qrr 1;� <br /> CONTRAC70R PHONE: 425�22-1744 CONTRACTOR EMAIL: rriecks mail.com <br /> CONT�tACTo��lc.# REXEL�S962N4 CITY OF EVERETT BUSIlVESS LfC.#048749 <br /> PRiMARY CONTACT: � OWNER C,7 CONTRACTCIR ❑OTH�R(Please Specify) <br /> CONi'AGT NAME:Robin Riecks CONTACT PHON� : 425-422-1744 <br /> _ <br /> CQNTAc7 EMAIL:rrieckS@gmait.GOm <br /> AGREEMENT.�T he�eGy cerfify that!have read and examined this application and kno.v the same to be true and correct. All provisions of laws and ordinancss governing!his <br /> type of�a�ork�vill be complefed whefher speciiied herein or not. The granting of a permit does not presume to give aufJ�ority to violate o�cancel the provisrons of any other state or <br /> /ocal lavv regulating consfruction or the performance oi construction. Thaf!am authorized by the ovvner of fhis property to perform the wo�k for which applicatron is made and I <br /> comply o-vith the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everetf O(ficral Use Only <br /> FEE <br /> ��2 - �-5 <br /> PERMIT# <br /> ' �.-. � ���� � ` ���� �-O� � _ <br /> owner/Authorized Agent Signature Date (Revised 90/12/?_095) <br />