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ELECTRICAL PERMIT APPLICATION <br /> 0EV ETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION ,/ <br /> PROJECT ADDRESS: 6003 23rd Dr W <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 1500 SF <br /> BUILDING TYPE: El SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Office buildin ,--. <br /> ELECTRICAL APPLICATION INFORM TION <br /> CONTRACT PRICE OF WORK,:(--$ 3,590.00 <br /> NUMBER OF DEVICES (if IowFvoltage): <br /> FIRE ALARM? ❑YES Il NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1801-017 <br /> DESCRIPTION OF WORK: : /+C•-j,,// .5 (ecq it- S i.;tc l.t,f / ,edo,,,ic f ifc. <br /> %, cam. <br /> O <br /> CONTAC INFORMATION <br /> OWNER NAME: TOC MANAGEMENT SERVICES TENANT NAME(If Commercial): Support Med <br /> OWNER MAILING ADDRESS: STREET 6825 SW Sandburg St <br /> cm ' Tigard STATE Oregon ZIP 97223 <br /> OWNER PHONE: NA OWNER EMAIL: NA <br /> CONTRACTOR NAME: Associated Electric <br /> CONTRACTOR ADDRESS: STREET PO BOX 280 <br /> /c Snohomish STATE WA zip 98291 <br /> CONTRACTOR PHONE: 425-334-1955 CONTRACTOR EMAIL: banderson@associatedelectric.net <br /> CONTRACTOR LIC.#(REQUIRED): EC ASSOCECO88NL CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 025969 r <br /> PRIMARY CONTACT: ❑OWNER 2 CONTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-334-1955 <br /> Brent L Anderson CONTACT EMAIL: banderson©associatedelectric.net <br /> AGREEMENT.I hereby certify that 1 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 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> ,t.--7' . / <br /> PERMIT# <br /> 3 2;1/.1 <br /> E ,g03 - ((--V-4 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />