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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 � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��J�9 �3211CI St. SE, Suite G & H <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 360.00 <br /> NUMBER OF DEVICES (if low volta e): z <br /> FIRE ALARM? ❑YES � NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Installation of two (2) thermostats. <br /> CONTACT INFORMATION <br /> OWNER NAME: ALGEM II TENANT NAME(If Commercial): PBCIfIC D211t81 SefVICeS <br /> OWNER MAILING ADDRESS: srREer 15815 NE 49th St. <br /> �,n Redmond STATE WA Z,P 98052 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: EVefgfeefl Reff1g2�8tlOf1 <br /> CONTRACTOR ADDRESS: srREEr 727 South Kenyon St. <br /> cin. Seattle STATE WA ZiP 98108 <br /> CONTRACTOR PHONE: 206-763-1744 CONTRACTOR EMAIL: aI@Xb�G eV@I'gl'221lflVaC.COI71 <br /> coNTt�,cTOR uc.#�REQuiREo�: EVERGRL954R2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044350 <br /> PRIMARY CONTACT: ❑OWNER PJ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2Q6-763-1744 <br /> Alex Burkhart coNTa,cr eMAi�: alexb@evergreenhvac.com <br /> AGREEMENT.I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing this type <br /> of work will be comp/eted whether specified herein or not. The granting of a permit does not presume to give authority to vio/ate or cancel the provisions of any other state or <br /> local law regu/ating construction or the pertormance of construction. That I am authorized by the owner of this property to peAorm 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 /> � � �;'iz,�cg E 1 �� � -- Og� <br /> G��, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />