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LECTRICAL PERMIT APPLICATION <br /> I�►' - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 10025 19th Ave SE, Suite 200 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ®COMMERCIAL <br /> USE OF BUILDING: Teeth <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ $3550.00 <br /> NUMBER OF DEVICES(if low voltage): 2 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 2 Double Cat 6 ports, 2 120 volt receptacles for computer and copier <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): Hughes Dental <br /> OWNER MAILING ADDRESS: STREET 10025 19th Ave SE, Suite 200 <br /> crry Everett STATE WA zip 98208 <br /> OWNER PHONE: 425-337-6885 OWNER EMAIL: <br /> CONTRACTOR NAME: Eylander Sales & Service <br /> CONTRACTOR ADDRESS: STREET 3601 Everett AVe <br /> c,T,r Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016363 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) j000hn LONG FANG <br /> CONTACT NAME: CONTACT PHONE: 425.231.2275 <br /> dr JOHN FANG CONTACT EMAIL: <br /> 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 <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 lam authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E go - ort( <br /> Owner/Authorized • ent Signature D e (Revised 9/23/2016) <br />