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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATtQN <br /> PROJECT ADDRESS: 3630 RallWay AV@ 9HZO�-3H77 <br /> BUILDING AREA(if residential, new construction, remodel, or addition)4740 SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: m COMMERCIAL <br /> USE OF BUILDING: <br /> '' ELECTRICAL APPLICATION INFt1RMAT10N` _ <br /> CONTRACT PRICE OF WORK: $ $15160.00 <br /> NUMBER OF DEVICES if low volta e : 44 <br /> FIRE ALARM? m YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF WORK: Fire Alarm upgrade <br /> CONTACT INF�RMAT�ON <br /> OWNER NAME: PUg2t SOUf1d Efl@fgy TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReEr 10885 NE 4th St <br /> �,n Bellevue STATE WA Z,P 98004 <br /> owNER PHONE: 425-456-2450 OWNER EMAIL: RObeft.KUChCI11Skl@pSe.COR1 <br /> coNTwacTOR Na,ME: Simplex Grinnell dba Tyco Westfire <br /> CONTRACTOR ADDRESS: srReeT 9520 �Otll AV2 SOUtfI #�OO <br /> �,n Seattle ST,,TE WA Z,P 98108 <br /> CONrRACTOR PHONE: 509-344-9427 CONTRACTOR EMAIL: G@GIbSOfl�q tyCO.COtTI <br /> CONTRACTOR LIC.#(REQUIRED): SIMPLL*977LE CITY OF EVERETT BUSINESS LIC.#(REQUIR • 050211 <br /> PRIMARY CONTACT: ❑OWNER Ql CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 509-344-9427 <br /> Gerry Gibson CONTACT EMAIL: GeGIbSOtI C�/tyCO.COt11 <br /> AGREEMENT:I hereby certify that I have read and examined this app/ication 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 1 am authorized by the owner of this property to pertorm the work for which application is made and I <br /> comp/y with the State Confractors Law 18.27 RCW and 296.200 WAC. <br /> �2r-� . �� CU <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Gerry A Gibson 11 /17/2016 E �(� l l -- �30 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />