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OLT 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
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<br /> PROJECT ADDRESS: 10627 19th Ave SE, Everett
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL
<br /> USE OF BUILDING: Commercial
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<br /> CONTRACT PRICE OF WORK: $ 200
<br /> NUMBER OF DEVICES(if low voltage): 1
<br /> FIRE ALARM? ❑YES El NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: Install (1) illuminated monument sign
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<br /> `NA CONTACT I IFORMA1If N
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<br /> OWNER NAME:BEC BUILD LLC TENANT NAME(If Commercial): Cooley Smiles Dentistry
<br /> OWNER MAILING ADDRESS: STREET 18031 67TH AVE NE
<br /> ,,T,, Kenmore STATE WA ZIP 98208
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Tube Art Group
<br /> CONTRACTOR ADDRESS: STREET 11715 SE 5th St
<br /> Cir.,Bellevue STATE WA ZIP 98005
<br /> CONTRACTOR PHONE: 206.679.8732 CONTRACTOR EMAIL: shawnb@tubeart.com
<br /> CONTRACTOR LIC.#(REQUIRED): EC TUBEADI 110NH CITY OF EVERETT BUSINESS LIC.#(REQUIRED):006667
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 206.679.8732
<br /> SHAWN BOWEN CONTACT EMAIL:shawnb@tubeart.com
<br /> tubeart.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 /> • r PERMIT#
<br /> • uthorized Agent Signature ate (Revised 9/23/2016)
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