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•ECTRICAL PERMIT APICATION <br /> /4IPV---*A- 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 i www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1706 Broadway <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 100.00 <br /> NUMBER OF DEVICES (if low voltage): 1 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Install 1 monument sign <br /> CONTACT INFORMATION <br /> OWNER NAME: Nursing Evolutions Pediatric Critical TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1706 Broadway <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Berry Sign Systems <br /> CONTRACTOR ADDRESS: STREET 7400 Hardeson Rd <br /> CITY Everett STATE WA ZIP 98203 <br /> CONTRACTOR PHONE: 425.776.8835 CONTRACTOR EMAIL: tracies@berrysignsystems.COm <br /> CONTRACTOR LIC.#(REQUIRED): berryss853w7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 24786 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.776.8835 x 114 <br /> Tracie Skiles CONTACT EMAIL:tracies@berrysignsystems.com <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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> I PERMIT# <br /> 7l? 1fl( IV <br /> E % 3 <br /> Owner/A en Signature Date (Revised 9/23/2016) <br />