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01/15/2007 18:40 142577 ACTIVE ENGINESFfhp PAGE 02/02
<br /> ELECTRICAL PERMIT APPLICATION
<br /> "11P4.7%,2:4,- CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-5310 l FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: 6623 Evergreen Way -
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: ❑SER-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS:.__.__._. ¢1 COMMERCIAL
<br /> USE OF BUILDING: Bank
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<br /> CONTRACT PRICE OF WORK:$ $500
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES ®NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK; Extend 20amp circuit for sump pump.
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<br /> OWNER NAME: TENANT NAME(If Commercial): Union Bank
<br /> OWNER MAILING ADDRESS: ssREtT 6623 Evergreen Way
<br /> crn. Everett STATE WA LIP 98203
<br /> OWNER PHONE: 425-258-4261 OWNER EMAIL:
<br /> CONTRACTOR NAME: Active Engineering/Neighborhood Electric
<br /> CONTRACTOR ADDRESS: asrtet—r 6605 200th St SW
<br /> ciTy Lynnwood srn're WA ZIP 98036
<br /> CONTRACTOR PHONE: 425-776-8119 CONTRACTOR EMAIL: admindesk@activeengineering.net
<br /> CONTRACTOR LIC.#(REQU}RED)_ ACTIVE*088MS CITY OF EVERETT BUSINESS LIC,#(REQUIRED):026248
<br /> PRIMARY CONTACT: L OWNER VI CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-776-8119
<br /> Bill Harris CONTACT EMAIL:admindesk@activeengineering.net
<br /> AGREEMENT I hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and onlinances governing this type
<br /> of work will be completed whether specified herein or not The granting or 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/am authorized by the owner of this property to perform the work for which appicadon is made and t
<br /> comply with the State Contractors Law 18.27 RCW and 296,200 WAG.
<br /> � City of Everett Official Use Only
<br /> J PERMIT#
<br /> (;:;1)( (-71;qn E \
<br /> owner/Authorized Agent Signature Date (Revised 9/13x2016)
<br />
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