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10/22/2017 10:29 FAX 425 377 1976 REX ELECTRIC Ijj001 <br /> joiip ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps©everettwa.gov 1 www.everettwagov/permits <br /> PIROJ..CT SITE <br /> INFORMATION <br /> PROJECT ADDRESS: ' � A <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ©SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTIFAMILY-It OF UNITS: .. COMMERCIAL <br /> USE OF BUILDING: ..€. ( rl <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 160 <br /> NUMBER OF DEVICES if low votta•e <br /> FIRE ALARM? 0 YES ! NO <br /> ASSOCIATED BUILDING PERMIT# nif a licable : _ <br /> DESCRIPTION OF WORK: /It 1 41VA f,#"th c <br /> CONTACT INFORMATION <br /> OWNER NAME:kla! �.warck. r TEN•,NT NAME If Commercial : <br /> OWNER MAILING ADDRESS: STREET 0-.47 <br /> 441 -61 <br /> crry <br /> . <br /> sT TE <br /> OWNER PHONE:`�� m 4 " OWNER EMAIL: y.1 a <br /> C.Q sTR .TO NA. EIectrie Service inc. <br /> CONTRACTOR ADDRESS: 11112 18th ST NE <br /> Lake Stevens WA 98258 STATE zsa <br /> CONTRACTOR PHONE:425422-1744 (CONTRACTOR EMAIL: rriecksagmaiLcorn <br /> CONTRACTOR LIC.#(REXELES962N4 ICITY OF EVERETT BUSINESS LIC.#048749 <br /> PRIMARY CONTACT: ei OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:Robin Riecks CONTACT PHONE:425-422-1744 <br /> CONTACT EMAIL:rriecks( gmail.com <br /> AGREEMENT:T hereby certify that l <br /> have read and examined this application and know the same fp be€nre 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 other state or <br /> local law regulating construction or the perfonnance of construction. That I am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> FEE <br /> 4°( [OS' 1(3-C <br /> PERMIT# <br /> .4711-"; 414(}4-"/". <br /> 1 /®_2/ .4/7 1 ©-- <br /> OwnertAuthorized Agent Signature Date (Revised 10/12/2015) <br />