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477 . <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2400 Lombard Ave. 98201 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Gazebo used as a small group rental facility <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 250 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ®NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Installation of a 20 amp, general purpose outlet for electrical power <br /> CONTACT INFORMATION <br /> OWNER NAME: City of Everett TENANT NAME <br /> (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 802 E. Mukilteo Blvd. <br /> CiTy Everett STATE WA zip 98203 <br /> OWNER PHONE: 4252578300 OWNER EMAIL: vmclaughlin@everettwa.gov <br /> everettwa.gov <br /> CONTRACTOR NAM <br /> CONTRACTOR ADDRESS: STREET 802 E. Mukilteo Blvd. <br /> Everett STATE WA <br /> zip 98203 <br /> CONTRACTOR PHONE: 4252577334 CONTRACTOR EMAIL: vmclaughlin@everettwa.gov <br /> CONTRACTOR LIC.#(REQUIRED): MCLAUVL314JS (EL-01) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-257-7334 <br /> Von McLaughlin CONTACT EMAIL:vmclaughlin@everettwa.gov <br /> AGREEMENT:I 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 /> • <br /> ((-2.7- 2.40/8 E kgo4 _ 20:0 <br /> Owner/, 1 ized Agent Signature Date 9 <br /> �r (Revise <br /> d /23/2016) <br />