1820 100TH PL SE SILVER LAKE DENTAL CLINIC 2018-01-02 MF Import

� � � �LECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 9a201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits ELECTRiCAL APPWCAT�QN INFORMATION CONTRACT PRICE OF WORK: $ 2000 NUMBER OF DEVICES if low voita e: FIRE ALARM? ❑ YES X❑ NO ASSOCIATED BUILDING PERMIT # if a licable : DESCRIPTION OF WORK: add (2) 20 amp 208 voit cirr,uits CONTACT INFQRMATtON OWNER NAME: ��r`��'r Lake C=arnily Dentaf TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREET 1820 100th PI SE #8E aTy Everett srnTE WA ziP 98208 OWNER PHONE: 425-337-240� OWNER EMAIL: CONTRACTOR NAME: VECA F_lectric CONTRACTOR ADDRESS: sTReer 5614 7th Ave S ciTv Seattle STATE W� ziP 9II108 CONTRACTOR PHONE: 206-436-5265 CONTRACTOR EMAIL: lesse.ct�apman@veca.com CONTRACTOR LIC. #(REQUIRED): VECAEC1542MU CITY OF EVERETT BUSINESS LIC. #(REQUIRED): Od4945 PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Jesse Chapman CONTACT PHONE: 206-436-5265 CONTACT EMAIL: jesse.chapman@veca.com AGFZEEMENT: T hereby certffy 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 authoiity to violate or cancel the provisions of any other state or local law regulating construction or the pertormance of construction. That 1 am authorized by the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE �� PERMIT # E l �- �'� (Revised 10/12/2015)