1617 BROADWAY 2017-10-03 - Laserfiche WebLink

SECTRICAL PERMIT AFf ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE R�A "�I�1: PROJECT ADDRESS:1617 Broadway AVE SW EVERETT WA BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL X USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1500 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: ALTERING 5 CIRCUITS CONTACT IN 'QRMATION T- OWNER NAME: ( b]TENANT NAME(If Commercial): AUTOZONE OWNER MAILING ADDRESS: srREEr v CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: MODERN LIGHTING LLC CONTRACTOR ADDRESS: PO BOX 735 SHELTON WA 98584 .,TATP 71P CONTRACTOR PHONE:360-789-1872 CONTRACTOR EMAIL:MODE RNLIGHTINGANDELECTRIC@GMAIL.COM CONTRACTOR LIC.#(REQUIRED):MODERLL879DH CITY OF EVERETT BUSINESS LIC.#(REQUIRED) PRIMARY CONTACT: ❑OWNER ❑XCONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: DERRICK Foley CONTACT PHONE: 360-789-1872 CONTACT EMAIL: MODERN LIG HTINGANDELECTRIC@GMAIL.COM AGREEMENT:Thereby 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 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/am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE PERMIT# Owner/Authorized Agent Signature Date (Revised 10/1212015)