8400 BROADWAY DSHS 2017-08-17 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov J www.everettwa.gov/permits :PRO OCT SITE INFORMATION PROJECTADDRESS: 840 N Broadway, Everett WA 98201 BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: DSHS Office ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 5,500.00 NUMBER OF DEVICES (if low voltage): 1 FIRE ALARM? ❑YES ® NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Alter one 30 amp Circuit and One 20 amp circuit. CONTACT INFORMATION OWNER NAME:DSHS TENANT NAME(If Commercial): DSHS Office OWNER MAILING ADDRESS: STREET 840 N Broadway Everett STATEWA ZP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Titan Electric CONTRACTOR ADDRESS: STIEET12828 NOrthup Way, Suite 205 ,,,,. Bellevue STAT--- WA z,P 98005 CONTRACTOR PHONE: 206-633-2811 CONTRACTOR EMAIL: SCOttM@tltanelectric.net CONTRACTOR LIC.#(REQUIRED): TitanE196308 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):051191 PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206_708-3048 Scout Mattson CONTACT EMAIL:SCOttrn@tltanelectric.ret 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 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 local law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application is made and t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# E OwOw e�zed Agent Signature Date (Revised 9123/2016)