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ELECTRtCAL PERMIT APPLiCATIC�N <br /> CITY OF EVERETf FERMIT SERVICES <br /> 3200 C�DAR STREET,EVERETT,WA 98209 <br /> (P)4�5-257-8810 � FAX 425-257-8857 �(Ej evereEteps@evereriwa.gov� www.everettwa.govtperrnits <br /> - � , <br /> :;. --�s '��� PltOJE�CT�SITE�IN��R�4AAT10N �;. �.��, � � �-<; <br /> �: „=: � .,.,,..,''�,...: � .. .�: <br /> PROJECT AODRE3$: 906 SE EVERETT MALL WAY STE i 30, EVERET?, WA 982U8 <br /> BUILDING AREA{if residential,new constnlcdon,remodel,or addiUan)�,380 � <br /> BUILDING TYPE: l�SFR-dETACHED ❑SFR-AT'fACHED L�DUPLEX ❑MULTI-FAMILY-#QF UN�TS: COMNiERC1AL <br /> USE OF BUILpING: Q�G@ <br /> _ <br /> ' "�� ' -. .::ELEC RICAL�:APP�.ICATION INFORMAT[ON.,��.'' �` ' <br /> CON7RACT PRICE OF WORK: 'I,040.00 <br /> NUMBER OF DEVIC�S if!ow v ta e : g <br /> FIRE ALAiZM? 0 YES N <br /> ASSOCIATED BUILDING PERMIT i� Itcable : <br /> DESCRIPTION oF WORK: installation of 9 low voltage voice and data cables. <br /> ; � � �` . :..CQNTACT.INFORMATION � �`� : <br /> ,::- ,,,.��� ,.�E�..... �� �`�,�..� <br /> � ._'� . . , _ z <br /> �,�.t a <br /> _. ... . �� '� _. � � . '� ��� <br /> OWNER NAME: H W LOCMIVER ENC T�N�HAME If comme�cial): H&R Block ` <br /> OWMER MAI�lNG ADDRESS: ��� 1823 S OHIO ST <br /> �,.SALINA 5TATE KS zu� 67409 <br /> OWHER PHQN�. ER EMAIL: <br /> CONTRACTOR NAM�: Wach#er, INC. <br /> CONTRACTQR ADDRESS: srnf�r� ST <br /> �m, Lenexa sra� KS z,P 6621 <br /> GONTRACi'OR PHONE: {913}227-3811 CONTRACTOR�MAfL: Samantha.Thomas@wachter.co <br /> CCINTRACTOR UC.#(REQUIRED): EG WACHTI"904KL C1TY OF EYERE7T BUSINESS LIC.#k(RECIU�RE :�`�3�$ <br /> PRIMARY CONTAC7: �OWNER �CONTRACT4R 0 OTh{ER(Please Specify);: <br /> CONTACT NAME: CONTACT PHONE: (g13)227-3$11 <br /> Samantha Thomas caHTACT�tt�:Samantha.Thamas@wachter.com <br /> AGREEIHFNT.�!iiereby eertify that t haMe read arret exammed th�s appkcef�On end know the sarne ta be trua and coned�AU <br /> aI work wiif be cwnpteted whether e ecifred hersin ot nel, The F+ovisidts ol ldws and ordraances govem�ng this rype <br /> p grantir�g nf a pemiit does not ptesurne fa glve aufhority to viotate or canwl!he Frovisians nl any olher stata er <br /> tocatlaw reguJating cw►sfruciFon or the perla'marica atconstrucUon::Th&!em authtsrized by ths awner pt}A�a prape�ty ta perlorm the worlc far whfch appticallon is made and! <br /> campfy with the Statn Cpnfroctors tnw f82T RCENand 296,Zf�'WAG> <br /> ��&; City of Everett OlJPciat Use OMy <br /> �t�ti s .. <br /> "�" �'� ,��` ���j��, PERMIT# <br /> �� ��� � `��'` ���` E l�- t C <br /> � ������P M �` �f.��/� � Z� <br /> _�,�"�- ,a <br /> t�:,s�rrr. <br /> er Authorized A�nt Signature °°��'� ` . ". '` rt e= (Rev7sed g/73l�prgj <br /> � ::��� � �t,°`�� ,� <br /> � <br /> �� <br /> . � !,r''�� �`�� <br /> ."�Ys'75'•^�,',.�i..��.�-'�/ '; �����'�. <br />