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gm' 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 ( (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 11 2Io Axe Po RT Rb, E vt✓RErr t.A 9 PZo y s rA"fk 3039 <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: 0 COMMERCIAL <br /> USE OF BUILDING: Community T nsit b.s shelter <br /> ELECTR CAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ $5,000.00 <br /> NUMBER OF DEVICES(if low volta.- : <br /> FIRE ALARM? 0 YES m NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C ka t 2 1 IO 11t`t <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 /> ,,Ty 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 5 0 23rd Pr -IA/ So;iv MO <br /> cry Everett STATE Wa. ZIP ti"'-` <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 10 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 510 3087 <br /> Brandon Judge CONTACT EMAIL:bjudge@elCOnCorp.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 /> ti/3/7—017 E --oCg <br /> Own Authorized Agent Signature Date (Revised 9/23/2016) <br />