Laserfiche WebLink
&ECTRICAL PERMIT APPLICATION <br /> CATION <br /> ____' A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4128 Rucker Ave [![ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED El DUPLEX El MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Grocery <br /> - I <br /> ELEC RICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: • 1400 <br /> NUMBER OF DEVICES(if low v. tage): <br /> FIRE ALARM? 0 YES :rd NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: disconnect and reconnect up to(10) 120v circuits and add up to(4) 120v 20 amp circuits <br /> CONTACT INFORMATION <br /> OWNER NAME: Safeway TENANT NAME(If Commercial): Are. <br /> OWNER MAILING ADDRESS: STREET 4128 Rucker Ave <br /> cm, Everett -(11-1LP'----- <br /> STATE WA ZIP 98203 <br /> OWNER PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME: SeaTac Electric Inc. <br /> CONTRACTOR ADDRESS: STREET 7056 So 220th St <br /> crry Kent STATE WA <br /> ZIP 98032 <br /> CONTRACTOR PHONE: 253-872-5553 'CONTRACTOR EMAIL: dawnianz@seataceiectric.com 7Th <br /> CONTRACTOR LIC.#(REQUIRED): SEATAEI077RW 'CITY OF EVERETT BUSINESS LIC.#(REQUIR D): 033037 <br /> PRIMARY CONTACT: El OWNER O CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-872-5553 <br /> CONTACT EMAIL:dawn.lanz@seatacelectric.com <br /> 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 <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 1 <br /> comply with the State Contractors Law 18.27 RC W and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> GGA <br /> 7)2 . E \ -- <br /> 50 <br /> Owner/Authorized Agent Si ature Date <br /> (Revised 9/23/2016) <br />