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10/21/2015 09: 06 2062911500 PAGE 01/01 <br /> ! G Cit 1• <br /> T� 5.., Dr� �� <br /> ELECTRICAL PERMIT APPLICATION. • <br /> CITY OF EVERETT PERMIT SERVICES - <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> • <br /> •. 425-257-8810 - FAX 425-257-8857 www.everettwa,gov <br /> 11001' " <br /> 1-321 ,.$1,104 Psi _ Level 3 .S, Bi Plane • 1, , <br /> '� <br /> PROJECT ADDRESS . <br /> Providence Gen Med Ctr, PO Box 1067, Everett,'.W.A. 90206-1067 425-258-7812 • . • <br /> Owner milif Address. City ' St <br /> ata2ip , Phone <br /> PRMC Everett, Colby Campus, 1321 Colby Ave, Everett WA 98201 206-320-2744 <br /> Tenant Mail Address City State/Zip Phone . <br /> VECA Electric, 5614 7th Ave South,. Seatitie WA 98108-2644 206-579-6895 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> VECAECI542MU 601190731 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Medical Bldg $4714.00 . <br /> Proposed Use of Building Contract Price of Work <br /> ** Sin1plexGrilnel1/Jafet Stebbins, <br /> • 206--291-146-8"---P-ERMIT CONTACT . <br /> Square Footage (If residential new construction,remodel or addition) ` <br /> . Contact Person/Contact Number/Email <br /> jastebbins@situplexgrinnell.cor . <br /> 6 <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Add (6) devices to Si Plane Level 3 South TI. Joint venture between <br /> Sim•lexGr,innell (•ermit contact) & VECA Electric install) . <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> `/ Q <br /> I hereby certify that l have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> - <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That 1 am authorized by the owner of this property to perform the E (Sin_ ( (0.--7 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 111 <br /> ./ 10/20/2015 <br /> �.e// 4/....4‘ / ,// .--\.;: / ;i .il;d. 7 ..0 ^:Hato= Date <br /> ** 206-291-1468 --- CONTACT SIMPLEXGRINNELL/JANET STEBBINS FOR VISA PAYMENT <br /> fr VIA TELEPHONE. THANK 1001 <br /> REVISSO I;d2� <br /> 1 <br />