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�41E77 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,::ii <br /> 8200 CEDAR STREET, EVERETT WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov i www.everettwa.govlpermits <br /> 14 <br /> 3 �lII� PROJECT SITE'INFORMATION. <br /> PROJECT ADDRESS; 12728 : 1 - ' o', u lte 101 - Everett, WA 98208 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 2000 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Dentist office in a commercial buildingELECTRICAL APPLICATIONINFORMATION <br /> CONTRACT PRICE OF WORK:$ 7000 <br /> NUMBER OF DEVICES(if low voltage <br /> FIRE ALARM? ❑'YES E NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Phone, Data and Audio wiring + surveillance Camera &Alarm System <br /> all \ vol e) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): Dr. Mark Stivers <br /> I <br /> OWNER MAILING ADDRESS: STREET 12728 Bothell-Everett Hwy, Suite 101 <br /> cirx Everett STATE WA zip 98208 <br /> OWNER PHONE: (360) 424-7057 OWNER EMAIL:markstiversdds@frontier.com <br /> CONTRACTOR NAME: Max Technologies, LLC <br /> l'''' <br /> CONTRACTOR ADDRESS: STREET 900 1St AVe South <br /> otry Seattle STATE WA ZIP 98134 <br /> CONTRACTOR PHONE: (206) 682-2887 CONTRACTOR EMAIL: info@maXtechseattle.com <br /> CONTRACTOR LIC.#(REQUIRED): MAXTETL904MN CITY OF EVERETT BUSINESS LIC.#(REQUIRED):049811 <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> 41 <br /> CONTACT NAME: CONTACT PHONE: (206) 669-7025 <br /> Erik Yurkanin CONTACT EMAIL:eyurkanin@maxtechseattle.com <br /> AGREEMENT.'l 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 ' <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 I 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 18.27 ROW and 296.200 WAG <br /> City of Everett Official Use Only <br /> PERMIT <br /> # <br /> Itti, .1 E 1(60 2--bc- <br /> • er/Autho d 4geht Signature Date (Revised 9/23/2016) <br />