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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 i (E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 10921 19th Ave Se E Everett <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: Gas Station <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 500.00 <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ❑YES ® NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: Replacing 2 wall packs on back of building <br /> CONTACT INFORMATION <br /> OWNER NAME: Chevron TENANT NAME(If Commercial): Chevron <br /> OWNER MAILING ADDRESS: STREET 10921 19th Ave SE <br /> ,,T,, Everett sTATE Wa zip 98208 <br /> OWNER PHONE: 425-316-9485 OWNER EMAIL: <br /> CONTRACTOR NAME: Sme Solutions <br /> CONTRACTOR ADDRESS: STREET 10107 South Tacoma Way <br /> c,Tv Lakewood sTATE Wa zip 98499 <br /> CONTRACTOR PHONE: 253-572-3822 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): Sme505L931 K1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 045511 <br /> PRIMARY CONTACT: ❑OWNER QI CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-572-3822 <br /> Mark Vigil CONTACT EMAIL: <br /> AGREEMENT:/hereby certify that I 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 I am authorized by the owner of this property to perform the work for which application 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 /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />