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47167 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE—INFORP ATKIN' ..'''"'' <br /> %.'Ft'• &,,:c �w 4.. .nw, ..�..,aw•a._ orti w.; .�:� '�ti•PROJECT ADDRESS: 1604-B BROADWAY AVE EVERETT, WA 98201 <br /> BUILDING AREA(if residential,new construction,remodel,or addition)1,190 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: Ca COMMERCIAL <br /> USE OF BUILDING: OFFICE <br /> �t-:T"'e• ?a'='s!?;�2• � ti� -� y...�,.�..q..-..,.�. .n...,�.�r_ `(�'•�:+'r.f; !' •ua s•. <br /> ELECT `ICAC ftW ATI70411 FQRMAT10N5t Z.gisl ' <br /> CONTRACT PRICE OF WOR :$ 2,000 <br /> NUMBER OF DEVICES(if to voltage): <br /> FIRE ALARM? 0 YES El NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> INSTALL 2-JUNCTION BOXES, 10-DUPLEX OUTLETS, 4X4 PHONE BOARD, SINGLE POLE LIGHT SWITC <br /> 2-PENDANT LIGHTS, EXHAUST FAN & LIGHT COMBO <br /> 'i ON'TACT:INFORMATION_--=j- <br /> OWNER NAME: H&R BLOCK TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1604-B BROADWAY AVE <br /> CRY EVERETT STATE WA zip 98201 <br /> OWNER PHONE: 425-239-6126 OWNER EMAIL: <br /> CONTRACTOR NAME: INFINITY CONSULTING, INC <br /> CONTRACTOR ADDRESS: STREET 2915 184TH AVE E <br /> CITY LAKE TAPPS STATE WA ZIP 983t <br /> CONTRACTOR PHONE: 253-405-0666 CONTRACTOR EMAIL: dmerritt@infinityconsulting.us <br /> CONTRACTOR LIC.#(REQUIRED): INFINCI998PP CITY OF EVERETT BUSINESS LIC.#(REQUIRED : 4039 <br /> PRIMARY CONTACT: ❑OWNER Cd CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-405-0666 <br /> DANA MERRITT CONTACT EMAIL:dmerritt@infinityconsulting.us <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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> • <br /> Owner/Aliorized/gent Signature • Date te (Revised 9/23!2016) <br />