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� <br />�_ <br />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 INFORMATION <br />PROJECT ADDRESS: 402 � 4tn st sE <br />BUILDING AREA (if residential, new construction, remodel, or addition) loo SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: C� COMMERCIAL <br />USE OF BUILDING: Pre Treatment building <br />EI.ECTRICAL APPLICATION 1NFORMATION <br />CONTRACT PRICE OF WORK: $ 1�So.00 <br />NUMBER OF DEVICES if low volta e: <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # if a licable : <br />DESCRIPTION OF WORK: Disconnect and Reconnect (2) xeat um s <br />CONTACT INFORMATION <br />OWNER NAME: city of Everett TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReEr <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: valley Flectric Co of Mt Vernon <br />CONTRACTOR ADDRESS: srReer 1100 Merrill Creek Parkway <br />C��, Everett SrnTE wA ZIP 98z03 <br />CONTRACTORPHONE: 4z5.4o�.o83z CONTRACTOREMAIL: Permitsc?velectric.com <br />CONTRACTOR LIC. #(REQUIRED): VALLEEC141NA CITY OF EVERETT BUSINESS LIC. #(REQUIRED): oz2ssa <br />PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 425.3zz.�426 <br />Meegan 'raylor CONTACT EMAIL: Meegant�velectric.com <br />AGREEMENT: T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />rype 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 pertormance of construction. That I 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Owner/Authorized Agent Signature <br />9/15/16 <br />Date <br />City of Everett Officia/ Use On/y <br />FEE <br />� vc `� �J <br />PERMIT # <br />E ���� r ��� <br />(Revised 10/12/2015) <br />