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�ECTRICAL PERMIT APp�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PRo�ecT aooRess: 1920 Merrill Creek Pkwy <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: $ 100 <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if ap licable : <br /> DESCRIPTION OF WORK: install one wall sign <br /> CONTACT INFORMATION <br /> owNert N�4neE: Staging &Design Network TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer 1920 Merrill Creek Pkwy <br /> �,n Everett STATE WA ziP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Bel'P)/Sl9tl SySt2111S <br /> coNTwacTOR a�oRess: S,-REET 7400 Hardeson Rd <br /> c,T, Everet srn� WA ZiP 98203 <br /> CONTRACTOR PHONE: 425.776.8835 CONTRACTOR EMAIL: tr8C18S�be1'1')/SlgnSySt@ITIS.00171 <br /> CONTRACTOR LIC.#(REQUIRED): berrySSH53W7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O247H6 <br /> PRIMARY CONTACT: ❑OWNER QI CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.776.8835 X 1 14 <br /> Tracie Skiles coNTacr eM�v�:tracies@berrysignsystems.com <br /> AGREEMENT.•l 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 goveming 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 O�cial Use Only <br /> �� � PERMIT# <br /> � <br /> � l � � ���� � �, E t �9 �-� ���I <br /> Owner/A riz6 Agent Signature Date (Revised 9/23/2016) <br /> � <br />