709 N BROADWAY 2019-01-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION O ,.,: CITY OF EVERETT PERMIT SERVICES 3200 CEDAR,STREET, EVERETT,WA 98201 (P)425a-257-8810 I FAX 425-257-8857 I (E)"everetteps a evere twa_gov I www.everettwagovlp r its PROJECT ADDRESS: 709 N. Broadway BUILDING AREA(if residential,new construction,remodel,or addition) SF m BUILDING TYPE: 0 SFR-DETACHED 0 SFRATTACHED 0 DUPLEX_ 1 MULTW«FAMILY- OF UNITS: 11 COMMERCIAL •USE OF BUILDING: Wa DOT Everett CONTRACT PRICE OF WORK:$ 18,000,00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES I;i NO ASSOCIATED BUILDING PERMIT#(if applicable): M.1804-042 DESCRIPTION OF WORK: New 120v/208v circuits for 4 new HVAC units • OWNER NAME: , TENANT NAME(If Commercial): Wa DOT Everett OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Busack Electric, Inc. CONTRACTOR ADD`ESS: STREET PO Box 1579 cm( Longview STATE WA ZIP 1;4*:. CONTRACTOR PHONE: 360:414.0144 CONTRACTOR EMAIL: kellibusaQ1 ( busackelectrlc." • CONTRACTOR LIC,#(REQUIRED): BUSACE1930K2 CITY OF EVERETT BUSINESS LIC.#(RECZUI-ED)* ll PRIMARY CONTACT: in OWNER Cl CONTRACTOR ©`OTHER:(Please Speciflt) CONTACT NAME: CONTACT PHONE: 360.414.0144 Kepi Busack CONTACT EMAIL:kellibusack<z busackelectric.corn AGREE-MEW:.)hereby ratify that f have read and examined this application and know the same to be true and correct: Aff proViSiOnS ofinws anteordinances governing this typo of work will be completed whether spScrfredherein;ornot, The granting of a permit does not presume to give authority to violate or conceithe:provisions of any othher state or focal law regulating construction or the performance of construction. That!am authorized by the owner of this property to perform the•work for which application is>made and i comply with the State Contractors Law/8.27 ROW and 288.200 WA.C. Oily of Everett Official Use Only PeRMI7`# 16,kg E (eof4. - 03c1 .. ...... .. Owner • +a .-zed Agent Signature Date (Revised 9/23!'2016)