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.ECTRICAL PERMIT AF : LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 400 W Sievers Duecy Rd <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: la COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 100.00 <br /> NUMBER OF DEVICES (if low voltage): 1 <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Replace damaged score board modules <br /> CONTACT INFORMATION <br /> OWNER NAME: Everett Parks & Rec Dept TENANT NAME(If Commercial): Phil Johnson Ballfield <br /> OWNER MAILING ADDRESS: STREET 802 Mukilteo Blvd <br /> C,Ty Everett STATE WA zip 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Berry Sign Systems <br /> CONTRACTOR ADDRESS: STREET 7400 Hardeson Rd <br /> CITY Everett STATE WA Z,p 98203 <br /> CONTRACTOR PHONE: 425.776.8835 CONTRACTOR EMAIL: tracies@berrysignsystems.com <br /> CONTRACTOR LIC.#(REQUIRED): berryss853W7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 24786 <br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.776.8835 X 114 <br /> Tracie Skiles CONTACT EMAIL: tracies@berrysignsystems.Com <br /> AGREEMENT:1 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 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 construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> t PERMIT# <br /> s - E � o - <br /> bwher/Autho#ed Agent Signature Date (Revised 9/23/2016) <br />