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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> Xerox Everett 1710 100th Place SE <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Xerox <br /> Tenant Mail Address City State/Zip Phone <br /> Titan Electric, Inc. 12828 Northup Way Stuite 205 Bellevue WA/98005 206-63 <br /> 3-2811 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> TITANEI963OB 051191 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Commercial $4,386.00 <br /> Proposed Use of Building Contract Price of Work <br /> Laurissa Carroll/206-735-9498 <br /> laurissac@titanelectric.net <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> 16 <br /> Number of devices(If low voltage) <br /> Install (1) ACP (I) Burg Panel, (1) Power Supply, & (1) 120v circuit. Install and <br /> Description of Work to Be Done: <br /> Terminate (2) Card Readers (2) REX's (4) Door Contacts (1) Key Pad & (4) CCTV Camera's. Terminate <br /> (2) Door Strikes. Titan Job #166080 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and "[ <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E l (00 - D <br /> LM <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and l <br /> 296.200 WAC. <br /> 5/3/16 <br /> Signature Date <br /> REVISED 08/06/2014 <br />