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4677 E!ECTRICAL PERMIT M T APRICATION <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: 4128 Rucker Ave Everett, WA 98203 <br /> BUILDING AREA(if residential,new construction,remodel,or addition)40,000 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Safeway Grocery Store <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 7000.00 <br /> NUMBER OF DEVICES(if low voltage): 30 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Hook up CCTV cameras. Cable already pulled and terminated by different company. <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): Safeway <br /> OWNER MAILING ADDRESS: STREET 4128 Rucker Ave <br /> cm. Everett STATE WA zip 98203 <br /> OWNER PHONE: 425-258-3552 OWNER EMAIL: <br /> CONTRACTOR NAME: Northwest Low Voltage, INC. <br /> CONTRACTOR ADDRESS: STREET 17026 SE 326th Place <br /> c,TM Auburn STATE WA zip 98092 <br /> CONTRACTOR PHONE: 253-279-9770 CONTRACTOR EMAIL: nwlowvoltage@comcast.net I <br /> CONTRACTOR LIC.#(REQUIRED): NORTHLV954B5 CITY OF EVERETT BUSINESS LIC.#(REQUIR D): <br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-279-9770 <br /> Tom Mellor CONTACT EMAIL:nwlowvoltage@comcast.net <br /> AGREEMENT:I 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 type <br /> 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 performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> / a --( —f8 Elul© - C91,9 <br /> wnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br />