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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: 11030 EVERGREEN WAY, EVERETT, WA 98206 <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: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1100. <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ❑YES Z NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: NEW POLE MOUNTED SERVICE FOR CABLE BOX <br /> CONTACT INFORMATION <br /> OWNER NAME:CABLECOM TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 8602 MALTBY RD <br /> ,.,y WOODINVILLE STATE WA z,, 98072 <br /> OWNER PHONE: 360-739-8520 OWNER EMAIL:TED.HAUGSTAD@CABLECOMLLC.NET <br /> CONTRACTOR NAME: AHEARN ELECTRIC <br /> CONTRACTOR ADDRESS: ST1EET8483 AUTO CENTER WAY <br /> , BREMERTON STATE WA zip 98312 <br /> CONTRACTOR PHONE: 360-373-1900 EXT 108 CONTRACTOR EMAIL: KIMBERLY@AHEARNELECTRIC.NET <br /> CONTRACTOR LIC.#(REQUIRED): AHEARE1008PA ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360_265-8769 <br /> ERIK TANGEN CONTACT EMAIL:KIMBERLY@AH EARN ELECTRIC.NET <br /> AGREEMENT.-1 hereby certify that/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 t am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Kimberly Washburn 4/12/17 E X9-0 0 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />