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01/09/2007 20:51 142577T ACTIVE ENGINEER PAGE 02/02
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> ,�as (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwagov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 10702 4th Ave SE
<br /> BUILDING AREA(if residential,new construction,remodel,or addition), SF
<br /> BUILDING TYPE: in SFR-DETACHED in SFR-ATTACHED D DUPLEX D MULTI-FAMILY-#OF UNITS: In COMMERCIAL
<br /> USE OF BUILDING: Residence
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<br /> CONTRACT PRICE OF WORK:$ 1 a00
<br /> NUMBER OF DEVICES(if low voltage): 1
<br /> FIRE ALARM? CI YES ®NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: Swap out 200amp panel,
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<br /> OWNER NAME: Cynthia Brown TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: ErreEr 10702 4th Ave SE
<br /> c,ry Everett STATE WA zn. 98208
<br /> OWNER PHONE: 425-347-2610 'OWNER EMAIL:
<br /> CONTRACTOR NAME: Active Engineering/Neighborhood Electric
<br /> CONTRACTOR ADDRESS: s„Eer 6605 200th St SW
<br /> Guy Lynnwood STA-n: WA zrr 98036
<br /> CONTRACTOR PHONE: 425-776-8119 'CONTRACTOR EMAIL: admindesk@activeengineering-net
<br /> CONTRACTOR LIC.#(REQUIRED): ACTIVE*OS8MS (CITY OF EVERETT BUSINESS LIC.#'(REQUIRED): 026248
<br /> PRIMARY CONTACT: ©OWNER WI CONTRACTOR D OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425.776-8119
<br /> Bill Harris CONTACT EMAIL:admindesk@activeengineering.net
<br /> AGREEMENT:I hereby calffy that I have read end examined this application and know the same to be true and correct. All provisions of laws and ordinances governing tri/s type
<br /> of work will be completed whether specified herein or not Tha 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 perfonnance of construction. That l am euIhorized by the owner of this property to perform the work for which application Is made and 1
<br /> comply with the State Contractors Law 18.27 RCW and 298,2o0 WAC,
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> lk to((Lin E
<br /> Owner/Authorized Agent Signature Date (Revised 9123/2018)
<br />
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