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04/30/2018 07:04 FAX 425 377 REX ELECTRIC 2001 <br /> )•- - - _--=si i a a�a.i'.-s1 to A�T e 1111t 0\f ■_A M M!_._f A t_■_ <br /> Qy l- -- *,1/441V/-1. Om. %I IF AtiII 1 .V/'Ri \anal <br /> 421114196 1.4196 17" <br /> 3200 CEDAR S Ntt t, tvERE i T viii- 98201 <br /> (P)425-257-6610 j FAA 41b-1b1-titibt j (E)everetterstcvevereitwa.gov j www.everettWa.govlpornits <br /> --PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: G t7 Q O /14 6r,l'i'I/ &€( 1 . gieek--1-.)44t // <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED ❑DUPLEX 0 MULTI-FAMILY-*OF UNITS; 'COMMERCIAL <br /> USE OF BUILDING: A4 44" ,,, ✓lh <br /> _ ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ i'' C O 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? CI YES , NO <br /> ASSOCIATED BUILDING PERMIT#a <br /> ap�licable�: <br /> DESCRIPTION OF WORK: /'S�!"/GLS„{?, Dov /- /KZ. ,q. 1/4 <br /> VNI-7S <br /> CONTACT INFORMATION <br /> OWNER NAME: A V 6Z. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 66 Dom�,, ,,//,4'e-tY/�/ G'ce� ta- <br /> �t <br /> ciTr /•jie-d+`T4 .TATE zsg oy <br /> OWNER PHONE: 31 0 O OWNER EMAIL: im rod('J <br /> CONTRACTOR NAME- Rex EJecttic Service Inc_ <br /> CONTRACTOR ADDRESS: 11112 18th ST NE <br /> ~ <br /> Lake Stevens WA 98258 STATE ZIP <br /> CONTRACTOR PHONE: 425-422-1744 _ CONTRACTOR EMAIL: rrteckstUgmail.com <br /> CONTRACTOR LIC.#(REXELES962N4 - CITY OF EVERETT BUSINESS LIC.#048749 <br /> PRIMARY CONTACT: 114 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:Robin Riecks CONTACT PHONE:425-422-1744 <br /> CONTACT EMAIL:rrIecks(gmajl.com <br /> AGREEMENT;T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any others fate or <br /> local law regulating construction or the performance of construction. That t am authorized by the owner of this property to perforin the work for which application Is made end! <br /> comply with the State Contractors Law 18.27 RCW end 288.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ,qP00 <br /> PERMIT# <br /> z_g E B o - 20 <br /> Owner/Authorized Agent Signature to (Revised 10/12/2015) <br />