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05/17/2016 12:36 2062911500 PAGE 02/02
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<br /> k*err 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_ 1330 Rockefeller Ave , Everett, WA 98201
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<br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF
<br /> BUILDING TYPE: El SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: IN COMMERCIAL.
<br /> USE OF BUILDING: Medical Office Building
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<br /> CONTRACT PRICE OF WORK: $ 29, 070 . 00
<br /> NUMBER OF DEVICES(if low voltage): 75
<br /> FIRE ALARM? El YES . ❑NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: •Add (75) devi c .s to Level 3 Tenant ImprovPrrten t . MOB Col by
<br /> Will tie to existing fire alarm system
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<br /> OWNER NAME: prov&denc Rjacj-i r'n- 1 Mari 'rr t rTENANT NAME(IfCommerclal):
<br /> OWNER MAILING ADDRESS: STREET 1321 Co]by Ave, Colby Campus •
<br /> are Everett STATE WA_ zip 98201
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME; S imp l exGr inne l l
<br /> CONTRACTOR ADDRESS: smEer 9520 10th Ave S . Suite 100
<br /> CITY Seattle STATE WA ZIP 98108
<br /> CONTRACTOR PHONE: 206-291-1400 CONTRACTOR EMAIL: jastebbins@simplexgrinnell .com
<br /> CONTRACTOR LIC_#REQUIRED): S IMPLII.I 9 81 SG CITY OF EVERETT BUSINESS LIC.#(REQU1REDt 6 02113334
<br /> PRIMEARY CONTACT: ❑OWNER CONTRACTOR '0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2 0 6-2 91-14 6 8
<br /> n5 CONTACT EMAIL: j astebbins@simplexgrinneil ,con)
<br /> AGREEMENT:T hereby certify that!have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this
<br /> 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
<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 10.27 RCW and 296.200 WAS.
<br /> Cnn^_�� �� // � ���' ���� City of Evereff Official Use Only
<br /> CJIJ�k - o o • FEE
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<br /> ��4Ai�i VLF a .
<br /> jv[ PERMIT#
<br /> / 5/17/16 LE \ l0
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<br /> - wne uthorize Agant Signature Date (Revised 10/12✓2015) •
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