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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 425-257-8810 - FAX 425-257-8857-www.everettwa.gov 1321 Colby Ave . Everett, WA 98206 PROJECT ADDRESS Providence Everett Medical Center 1321 Colby Ave. Everett WA 98206 425-261-4556 Owner Mail Address City State/Zip Phone Same as above . Tenant Mail Address City State/Zip Phone VECA Electric 5614 7th Ave Seattle WA 98108 206-436-5200 Electrical Contractor Mail Address City State/Zip Phone VECAECI542MU 004945 State License Number(required) City of Everett Business License Number(required) Healthcare - Bi-plane OR $124, 402 Proposed Use of Building Contract Price of Work Travis Ackerman, 206-696-7458 1, 180 travis . ackerman@veca. com Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email n/a Number of devices(If low voltage) Description of Work to Be Done: Build out shell space in interventional radiology area to create one new finished and furnished Bi-plane procedure room and modify an existing clean core room to add power and data outlets for equipment. FEE CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1 5°1�`t I hereby certify that I have read and examined this application and know the same to be true and I 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 PERMIT# violate or cancel the provisions of any other state or local law regulating construction or the I �� 2,2,qperformance 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. 9/24/15 Signature Date REVISED 08/06/2014