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ELECTRICAL PERMIT APPLICATION <br /> 7.;- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 10200 19th Ave SE <br /> BUILDING AREA(if residential,new construction,remodel,or addition)96 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Fuel Station <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 5320.00 <br /> NUMBER OF DEVICES(if low voltage): 24 Cables <br /> FIRE ALARM? 0 YES m NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Pull 24 Communication cables to the Fuel pumps <br /> CONTACT INFORMATION <br /> OWNER NAME:Costco Wholesale Corp TENANT NAME(If Commertl): COStCO <br /> OWNER MAILING ADDRESS: STREET 999 Lake Dr <br /> CITY Issaquah STATE WA ar 98027 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Bradley Botteron (Wachter Inc ) <br /> CONTRACTOR ADDRESS: sTREET 16001 W. 99th St <br /> cm Lenexa STATE KS aP 66219 <br /> CONTRACTOR PHONE: 913-227-3911 'CONTRACTOR EMAIL: samantha.thomas c@wachter.com <br /> CONTRACTOR LIC.#(REQUIRED): EC WACHTI*904KL 'CITY OF EVERETT BUSINESS UC.#(REQUIRED): 043582 <br /> PRIMARY CONTACT: 0 OWNER iZ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 913-227-3911 <br /> Samantha Thomas CONTACT EMAIL:Samantha.thomas@wachter.com <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 ornot. The granting of a penult 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 t am 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 1&27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ()1 E0 (0 ' a3/4 <br /> Owner/Authorize •• Signature Date (Revised 9/232016) <br />