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4rErr 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: 1125 4 RPoo-r RD. EVFIZFIT I V'4 99zoq .0.44 3ozo <br /> BUILDING AREA(if residential, new construction,remodel,or addition)400 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ®COMMERCIAL <br /> USE OF BUILDING: Community Transit bus shelter <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ $5,000.00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES m NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Construction of new bus shelter electrical service for lighting and passenger information display. <br /> 120/240 Volt single phase 60Amp new meter and service <br /> CONTACT INFORMATION <br /> OWNER NAME: Community Transit TENANT NAME(If Commercial): Todd Jacobs <br /> OWNER MAILING ADDRESS: STREET 7100 Hardeson Rd <br /> CITY Everett STATE Wa ZIP 98203 <br /> OWNER PHONE: 425 348 2367 OWNER EMAIL:todd.jacobs@commtrans.org <br /> CONTRACTOR NAME: Elcon Corporation <br /> CONTRACTOR ADDRESS: STREET 3'8OJ 214rd Pr W1 54/ I9 <br /> ci-- Everett STATE Wa. ZIP 982.13 <br /> CONTRACTOR PHONE: 206 510 3087 CONTRACTOR EMAIL: bjudge@elconcorp.com <br /> CONTRACTOR LIC.#(REQUIRED): ELCONC*128J1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 014943 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 510 3087 <br /> Brandon Judge CONTACT EMAIL: bjudge@eIconcorp.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 /> .146 <br /> (I/777 E - o4-L <br /> r Date (Revised 9/23/2016) <br /> Owner/Authorized Agent Signature <br />