9404 EVERGREEN WAY 2017-10-20 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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 I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 9404 Evergreen Way 98204 BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: la COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1,000 NUMBER OF DEVICES (if low voltage): 1 FIRE ALARM? ❑YES ONO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: Install AES radio to monitor existing FACP CONTACT INFORMATION OWNER NAME: DawnSon Clark Chiropractic TENANT NAME(If Commercial): Dawson Clark Chiropractic OWNER MAILING ADDRESS: STREET 9404 Evergreen Way c T., Everett STATE WA 1, 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Guardian Security Systems CONTRACTOR ADDRESS: STREET 1501 Kentucky St aTv Bellingham STATE WA zip 98229 CONTRACTOR PHONE: 360-647-0110 CONTRACTOR EMAIL: SOdell@guardlansecurity.com CONTRACTOR LIC.#(REQUIRED): GUARDSS233K5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0033443 PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-647-0110 ext.327 Shelramie Odell CONTACT EMAIL: SOdell@guardlansecurlty.Com AGREEMENT:1 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 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only Digitally signed by Sheramie Odell PERMIpT# (~ s ✓_ I Date:2017.07.06 13:05:12 E `"--�-07'00' Owner/.Authorized Agent Signature Date (Revised 9/23/2016) l