10921 19TH AVE SE 2019-06-11 - Laserfiche WebLink

PLECTRICAL PERMIT APPLICATION "j—g - CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettvva_gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10921 19th Ave SE,Everett WA 98208 Parcel#00574700200101 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: ®COMMERCIAL USE OF BUILDING: Chevron Gas Station & Extra Mile ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1,000.00 NUMBER OF DEVICES (if low voltage): 2 @ 60w 15v LED drivers FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Ni Wire new LED gas price faces in pole sign to existing electrical circuit: CONTACT INFORMATION OWNER NAME: Chevron USA Inc. TENANT NAME(If Commercial): Chevron#91183 OWNER MAILING ADDRESS: STREET PO BOX 1392 cm, Bakersfield STATE CA zip 93302 OWNER PHONE: Jessica Halverson (253)797-6545 OWNER EMAIL: JEHU@Chevron.com CONTRACTOR NAME: Insignia Sign Inc. CONTRACTOR ADDRESS: STREET PO BOX 2849 CITY Renton STATE WA ZIP 98056 CONTRACTOR PHONE: (425)917-2109 CONTRACTOR EMAIL: Steven@insigniasign.com CONTRACTOR LIC.#(REQUIRED): INSIGSIO55JS CITY OF EVERETT BUSINESS LIC.#(REOUIRED):038029 PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (425)917-2109 Steven Thomson @ Insignia Sign Inc. CONTACT EMAIL: steven@insigniasign.com AGREEMENT::!hereby certify that l 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 t am authorized by the owner of this property to perform the work for which application is made and t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# t r SIersesi Tho0 so. (Contractor&Agent) 10/10/17 E Owner/Authorized Agent Signature Date (Revised 9/23/2016)