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� <br />� <br />�ECTRICAL PERMIT AP�ICATION <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.everetiwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 4128 RUCKER AVE <br />BUILDING AREA (if residential, new construction, remodel, or addition)____ SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: �❑ COMMERCIAL <br />USE OF BUILDING: SAFEWAY (AMAZON LOCKER) <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ 1000 <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES 0 NO <br />ASSOCIATED BUILDING PERMIT # (if applicable : <br />DESCRIPTION OF WORK: PROVIDE AND INSTALL (1) 120V RECEPTACLE FOR AMAZON LOCKER. <br />CONTACT INFORMATION <br />OWNER NAME: BRENDAMOIR MOVING TENANT NAME (If Commercial): SAFEWAY#1484 <br />OWNER MAILING ADDRESS: STREET 2630 GLENDALE MILFORD RD. <br />cin, CINCINNATI STATE OH zia 45241 <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: SEA-TAC ELECTRIC, INC. <br />CONTRACTOR ADDRESS: STREET �056 S.220TH ST <br />cin, KENT sTATE WA ziP 98032 <br />CONTRACTOR PHONE: 253-872-5553 CONTRACTOR EMAIL: corey.mckinnon@seatacelectric.com <br />CONTRACTOR LIC. #(REQUIRED): SEATAE1077RW CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 53530 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR O OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT.• T hereby certify that I have read and examined this applicafion and know the same to be true and correct. All p�ovisions of laws and ordinances governing this <br />type of work will be completed whether specified herein or not. The granting of a pe�mit does not presume to give authority to violate or cancel the provisions of any other state or <br />local law regulating const�uction or fhe perfo�mance of construction. That I am 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 />3/15/2016 <br />Agent Signa4ure Date <br />City of Everett O�cial Use Only <br />FEE <br />���•s° <br />PERMIT # <br />E 1�o�3-ls / <br />(Revised 10/12/2015J <br />