3702 BROADWAY 2019-01-18 - Laserfiche WebLink

ELECTRICALPERMIT APPLICATION ° � CITY OF EVERETT PERMIT SERVICES. 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)evetotteps(+ ever.etthtra.gov vvvvmeveret-Magoviperrnits PROJECT SITE INFORMATION PROJECT ADDRESS: 3702 Broadway BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SPR ATTACHED 0 DUPLEX 0 MULTI-FAMILY`-#OF UNITS: ei COMMERCIAL USE.OF BUILDING: Gas Station ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK$ 3000.00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES ISI NO ASSOCIATED BUILDING PERMIT (if applicable): N/A DESCRIPTION OF WORK: Replace exisiting fuel dispensers with new fueldispensers,extend wiring as needed. CONTACT INFORMATION OWNER NAME: TENANT NAME of cornrclal):.Shell Mart _ z OWNER MAILING ADDRESS; STREET 3702 Broadway coy Everett STATE WA zip 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Independent Elecetrical Services, LLC CONTRACTOR ADDRESS: sTatET209 N Frederick St. my Post Falls STATE ID zip:83854 CONTRACTOR PHONE:208-699-5511 CONTRACTOR EMAIL: les2003j?gmail.corn CONTRACTOR LIC.#(REOUIFRED): INDEPES947C8 _CITY OF EVERETT BUSINESS UC.#(REQUIRED): PRIMARY CONTACT:. D OWNER ®CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 208-899-5511 Jason I Shoemaker CONTACT EMAIL:ies2003j,cl gmail.colrt AGREEMENT::I hereby cert*that J have read end examined this application and know the same:to betrue and domed, AS provisions(#laws and ordinances governing this type of work will be completed whether specified herein or not The granting of a permit does not presume to give authorityto violate or cancel the provisions of any other state or local lawregulating oonstroction or the performance of construction That lam authorized by the ownerof this properly to perform the work for which applieetion is made and I comply with the State Contractors Lew 18,27RCWand 296,200 WAC, Cit rot Everett Official Use Only PERmiT#: 0,..25 .- / ' � I s5 , /Authori ed Agent Signature /1/ ate (Revised 9/23/2016)