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ELECTRICAL PERMIT APPLIGATION <br /> CITY QF EVERETT PERM{7 SERVICES <br /> 320Q CEDAR STREET, EVERETT, WA�8201 <br /> (P)425-257-8810 � FAX 425-257-8857 ( {E)everetteps@everettv�a:gov j www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> �—r <br /> PROJECT ADDRESS; Group Health 2930 Mapie Street Everett,WA 982Q1 ��__.. <br /> BUILDING AR�A(if residential, new construction, remodel,or addition} 200� SF <br /> BUI�DING TYPE: L�SFR-DETACHED ❑SFR-ATFACHED ❑ DUPLEX ❑ MULTI-FAMILY-#QF UNITS: �COMMERCIAL <br /> USE OF SUILDING: <br /> ELECTRICAL APPLICATION INFORMATII�N <br /> CQNTRACT PRICE OF WORK:$ 10,OOO.QO <br /> NUMBER OF DEVICES if low vokta e): 30 <br /> FIRE ALARM? ❑YES (�NO <br /> ASSOCIATED BUILDING PERMIT# if ap licable : <br /> DESCRIPTION OF WORK: Low Voltage Gommunications Cabling <br /> CONTACT INFORMATION <br /> OWNER NAME: 7ENANT NAME(If Commercial): Group Health <br /> QWNER MAILkNG ADDRESS: srREeT <br /> CITY STATE ZIF� <br /> OWNEFt PHONE: OWNER EMAII.: <br /> CONTRACTOR NAME: Evergreen Technologies inc <br /> CQNTRACTOR ADDRESS: sTReeT 3623 East Marginal Way S <br /> cm Seattle srnTE WA z�a 98134 <br /> CONTRACTOR PHaNE: 06-774-1363 CONTRACTOR EMAIL: mcan@evergreentec.com <br /> CONTRACTOR IIC.#(REQUIRED): EVERGTI929K9 �[TY OF EVERETT BUSINESS LIC.#(REQUIRED); 050'(82 <br /> PRIMARY CONTACT; p OWNER �1 CONTRACTOR �OTHER(Please Specify) <br /> CONTAC7 NAME: �eryem Cafl CONTACT PHONE: �p�_77,�_�g�� <br /> CONTACT EMAIL: mcan@evergreentec.cam <br /> kGREEMENT. T hereby aeRiiy that/have read and examined this appfication end know the same fo be true and Gotrecl. A!1 provisrons of laws and ordinances govemiag thrs <br /> type of wa�k will be comptet�d whether specified herein or nof. The granting af a parmrt does not presume to give autboriry to viplate orcancel the provrs±ons of any otherstate or <br /> loca!laav tegulating constructian or the perfarmance ol construction. That!am authorized by the owner of this property to perlorm the work for which application is macle and! <br /> comply Gvith fhe State Contractors Law 18.27 RCW and 296.200 WAG <br /> City of Everett Officia!Use Only <br /> FEE <br /> � - ' - � <br /> �%�,��' _ <br /> _ PERMIT# <br /> _.� " � � <br /> , � <br /> ,�,,� � �3 � � E '������ � �-� �;���� <br /> wnedAuth rized Agent S ture Date (Revised 10/i2/2015) <br />