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0477 ELECTRICAL PERMIT APPLICATION <br /> 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: 5700 23rd Dr. W <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ® COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 200.00 <br /> NUMBER OF DEVICES (if low voltage): 1 <br /> FIRE ALARM? 0 YES m NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: Relocation of one (1) remote sensor. <br /> CONTACT INFORMATION <br /> OWNER NAME: Northshore Christian Church TENANT NAME(If Commercial): Northshore Christian Church <br /> OWNER MAILING ADDRESS: STREET 5700 23rd Dr. W <br /> cin, Everett STATE WA zip 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Evergreen Refrigeration <br /> CONTRACTOR ADDRESS: STREET 727 South Kenyon St. <br /> CITY Seattle STATE WA ZIP 98108 <br /> CONTRACTOR PHONE: 206-763-1744 CONTRACTOR EMAIL: alexb@evergreenhvac.com <br /> CONTRACTOR LIC.#(REQUIRED): EVERGRL954R2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044350 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-763-1744 <br /> Alex Burkhart CONTACT EMAIL: alexb@evergreenhvac.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 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 /> PERMIT# <br /> (tc3/4s E bf h <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />