1330 ROCKEFELLER AVE PEMC 3RD FLOOR 2021-08-30

ill ECTRICAL PERMIT APPLICATION CtsADV14-- 5' 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 PROJECT6�1�'SITE INFORMATION PROJECT ADDRESS: —a3�1 Colby 7) &c� _ s J e e BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: Hospital ELECTRICAL APPLICATION INFORATION CONTRACT PRICE OF WORK: $ 18,771.56 NUMBER OF DEVICES (if low voltage): 192 FIRE ALARM? ❑YES Ig NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: Low Voltage-Voice and Data Only-3rd Floor Renovation CONTACT INFORMATION OWNER NAME: Providence TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1321 Colby Ave. ciTY Everett STA-E WA z,a 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pacific Communications Cabling CONTRACTOR ADDRESS: STREET 10604 E. Riverside Dr. CITY Bothell STATE WA ZIP 98011 CONTRACTOR PHONE: 425-483-5957 CONTRACTOR EMAIL: trina@pacificcc.com CONTRACTOR LIC.#(REQUIRED): PACIFCC910L5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 035656 PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-483-5957 Katrina Nielsen CONTACT EMAIL: trina@pacificcc.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 PPEERMIT# K.Af- 't,1ca l�lU- n e 6/23/16 . Owner/Authorized Agent Signature Date (Revised 10/12/2015)