1031 SE EVERETT MALL WAY MODERN DENTISTRY 2019-01-29

ELECTRICAL PERMIT APPLICATION /11#40/V/ CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1031 SE Everett Mall Way BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: VI COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 300 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Install one internally-illuminated wall sign on the tenants main (south) exterior elevation. CONTACT INFORMATION OWNER NAME: EVERETT COVENANT GROUP LLC TENANT NAME(If Commercial): Everett Modern Dentistry OWNER MAILING ADDRESS: STREET 17000 RED HILL AVE c,T,. IRVINE STATE CA ZIP 92614 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Culberts .Sign Service CONTRACTOR ADDRESS: STREET 5209 122nd St E ciTr Tacoma STATE WA ZIP 98446 CONTRACTOR PHONE: 253-538-0752 CONTRACTOR EMAIL: csspermits@gmail.com CONTRACTOR LIC.#(REQUIRED): CULBESS842N6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053695 PRIMARY CONTACT: 0 OWNER VI CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-538-0752 Hans Visser CONTACT EMAIL:csspermits@gmail.com AGREEMENT.:I 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 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# /- 05/9/2.0)7 E n06- 11-11 Owner/Authorized Agent Signature ate (Revised 9/23/2016)