3927 RUCKER AVE BASE FILE 2020-01-30

ELECTRICAL PERMIT PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3927 Rucker Avenue BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: IX COMMERCIAL USE OF BUILDING: Medical Bldg. ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ LOQ Oj NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES ® NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: TEMP POWER JOB EC1819 CONTACT INFORMATION OWNER NAME: The Everett Clinic TENANT NAME(If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET 3901 Hoyt Avenue CITY Everett STATE WA 7IP 98201 OWNER PHONE: 42.5-25970966 OWNER EMAIL: N/A CONTRACTOR NAME: Dutton Electric Company,Inc. CONTRACTOR ADDRESS: STREET 12407 Mukilteo Speedway. A-170 CITY Lynnwood STATE WA ZIP 98087 CONTRACTOR PHONE:(425) 347-7600 CONTRACTOR EMAIL: info@duttonelectric.cor CONTRACTOR LIC.#(REQUIRED): DUTTOEC137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):019811 PRIMARY CONTACT: 0 OWNER 1S3 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: Brad Morin CONTACT PHONE: 425409-4854 CONTACT EMAIL: brad(c duttonelectric.com AGREEMENT:T 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 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE O , Digitally signed by Peita Smith DN:C=US, s E=peita@duttonelectric.com, PERMIT#Peita mithORU o",nO:IDtEeCsOoCtNaPceciuraScyiathnd integrity 6(13, 1 () ofe this document Date*2018.06 1 F 1043:05-07'00' Owner/Authorized Agent Signature Date (Revised 10/12/2015)