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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 INFORMATION <br /> PROJECT ADDRESS: 4�O� RUC{(eC AV2 <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: FU2� Statl011 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 5830.00 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES m NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Dispenser replacement, and incon tank monitor replacement <br /> CONTACT INFORMATION <br /> OWNER NAME: FOfeSt Pafk FUeI TENANT NAME(If Commercial): FOf@St Pafk Ch@VfOfl <br /> OWNER MAILING ADDRESS: srREEr P. O. BOX ZS4OO <br /> �,n Bellingham STATE WA Z,P 98228 <br /> owNER PHONE: 425-322-3165 OWNER EMAIL: <br /> CONTRACTOR NAME: IlltlOVatlVe E12CtfIC, Inc <br /> CONTRACTOR ADDRESS: sTREeT P. O. Box 4399 <br /> cnY Everett STATE WA Z,P 98204 <br /> CONTRACTOR PHONE: 425-290-7803 CONTRACTOR EMAIL: gUtlllaC'C�t ItIIIOVatIV@-@I@Ctl'IC.00171 <br /> coNTRacTOR uc.#�REQuiREo�: INNOVE1055KE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 36828 <br /> PRIMARY CONTACT: ❑OWNER CL7 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-290-7803 <br /> Gunnar Petzold coNTacT Ema,i�: gunnar@innovative-electric.com <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing fhis 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 constn�ction or the performance of construction. That I am authorized by the owner of this property to pertorm the work for which applrcation is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � , E I D�� �'� <br /> Owner/Authorized Agent Signatu Date (Revised 9/23/2016) <br />