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05/25/2018 14:40 FAX 425 377 1976 REX ELECTRIC 2001 <br /> �-- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps©everettwa.gov( www,everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: , 0 0 Ad 'Agr �i i i `JL_ - <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX D MULTI-FAMILY-#OF UNITS: PrCOMMERCIAL <br /> USE OF BUILDING: i'ill) CL . zi/J <br /> ECTRICAL AP•LICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ tr r <br /> NUMBER OF DEVICES if low volta•- <br /> FIRE ALARM? 0 YES i' 0 <br /> ASSOCIATED BUILDING PBRMIT#(I =• e): <br /> DESCRIPTION OF WORK: i , , Mir <br /> fr <br /> CONTACT INFORMATION <br /> OWNER NAME: ( i' TENANT NAME if C•mme Jai : —A g % l <br /> OWNER MAILING ADDRESS: STREET % , IIIVAMI rtrj�L/ L LAI, <br /> ` /Vb.-3 , 9,eze-ziCITY r 4. I. 1 h STATE r{ /1 / {t i 7 ZIP <br /> OWNER PHONE: OWNER EMAIL: DD" ��// / - <br /> CONTPAcsOR mum-Rax Electric Service Inc_ <br /> CONTRACTOR ADDRESS: 11112 18th ST NE <br /> Lake Stevens WA 98258 STATE - <br /> CONTRACTOR PHONE;425-422.1744 CONTRACTOR E ,: :rrieckstl3lcimall.com <br /> CONTRACTOR LIC_#(REXE!E8962N4 �.wii Ii VER - - _ NE .. ; m :749 <br /> PRIMARY CONTACT: ef OWNER 0 CONTRACTOR 0 OT 'Please Specify) <br /> CONTACT NAME:Robin RIecks TACT PHONE:425-422-1744 <br /> CONTACT EMAIL:Triecksegmail,com <br /> AGREEMENT:T hereby certify that I have read and examined WS a•. .(Ion and know the same to be true and co . . .visions of laws and Ordinances governing this <br /> type of WOMB Witl be completed whether specified herein or not. The gra • •of a permit does not presu authOrIty to violate or cancel the proNalona of any other state or <br /> local taw regulating construct/On or the performance of construction. That I a - _. .. _o or of this property to perform the work for which application is made and I <br /> comply with the Slate Conlracto s Lew 18.27 RCA/end 288.200 WAC. <br /> City or Evaiett Official Use Only <br /> FEE rr C <br /> LIQ 5� <br /> LPERMIT# <br /> /10,1 id" $0S _ 2� (. <br /> Own /Autho ed Agent Signature Date (Revised 10/12/2015) <br />