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0 0 <br /> ELECTRICAL PERMIT APPLICATION <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: 5811 H I G H WAY P L <br /> BUILDING AREA(if residential, new construction, remodel;or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS:9 ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 659.00 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if a licable <br /> DESCRIPTION OF WORK: REWIRE SHACK PANEL-, INSTALL 50AMP SO WHIP OFF INTERIOR SHACK PANEL <br /> CONTACT INFORMATION <br /> OWNER NAME:DR HORTON TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12910 TOTEM LK BLVD. NE#220 <br /> c,Y KIRKLAND ,TATE_ WA Z1, 98034 <br /> OWNER PHONE: 425-821-3400 OWNER EMAIL:NSA <br /> CONTRACTOR NAME: PROVIDENT ELECTRIC INC <br /> CONTRACTOR ADDRESS: STREET PO BOX 7087 <br /> UT, COVINGTON STATE WA Z,P 98042 <br /> CONTRACTOR PHONE: 2536317750 1CONTRACTOR EMAIL: PERMITS@PROVIDENTELECTRIC.NET <br /> CONTRACTOR LIC.#(REC7UIRF-D). PROVIEI 103C2 ICITY OF EVERETT BUSINESS LIC.#(RECUR ED):043329 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-631-7750 X 1028 <br /> SHANNON CHELETTE CONTACT EMAIL:PERM ITS PROVIDENTELECTRIC.NET <br /> AGREEMENT:I hereby certify Mat i have read and examined ibis application and know the same to be true and correct. All provisions of laws and ordinances governing th+s 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 cannel the provisions of any other state or <br /> lova!favi regulating construction or the perforrrranco of conshuctfvn That lam 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 /> PERMIT# <br /> Z�f-17 E �j0Co� ?-2� <br /> OwnerlAuthorized Agent Signature Dale (Revised 9/23/2016) <br />