6502 EVERGREEN WAY FIT BODY BOOT CAMP 2020-02-07

OLT ECTRICAL PERMIT AtICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 l FAX 425-257-8857 1 (E)everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6502 Evergreen Way BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 360.00 NUMBER OF DEVICES (if low voltage): 2 FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): 81901-026 DESCRIPTION OF WORK: Installation of two (2) thermostats. CONTACT INFORMATION OWNER NAME: Madison Real Property LLC TENANT NAME(If Commercial): Fit Body Boot Camp OWNER MAILING ADDRESS: STREET PO Box 31609 ciTy Seattle STATE WA ZIP 98103 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Evergreen Refrigeration CONTRACTOR ADDRESS: STREET 727 South Kenyon St. CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE: 206-763-1744 CONTRACTOR EMAIL: alexb@evergreenhvac.com CONTRACTOR LIC.#(REQUIRED): EVERGRL812DK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044350 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206-763-1744 Alex Burkhart CONTACT EMAIL:alexb@evergreenhvac.com evergreenhvac.com 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 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 local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# Owner/Authorized Agent Signature Date (Revised 9/23/2016)