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06/20/2014 14:54 2062911500 SIMPLEXGRINNELL PAGE <br />ELECTRICA,L PERMIT Ap�LII�ATION <br />CITY OF EVERET� PERMIT S��Vf,�CES <br />3200 CEDAR STREET, EVERETT, WA 98201' <br />�25-257-8810 - FAX 425-257-8857 — www,everett�tia:org <br />916 Pacific Ave (na�i'L-i� Campu,s - Floor 7- Fairfax) <br />PROJ�CT ADpR�SS <br />fROV/G�N MEDICA7, C�NTER PO BOX 11�7 E�7ER�TT WI� 98206 425-'?61-2000 <br />OWnEI' Mafl ftddros5 City 5tate/Zlp <br />Phone <br />425-261.-20b0 <br />P,r.ovidence l�agional MEd CCnt�.r, Pacif.a,c Camptts, 916 Pacific 11ve �vcr.etti In7A 98701 <br />Tenant Mail ,Address C�Ry State2lp Phone <br />McKinstr.y Co, Tnc PO Bax 24567 Sea�:tle Wn 98134 206-76?_-33�.1 <br />�leetrlcal Contractor Mail Address <br />MCK,T,NC.T,,9�2DN <br />Stafe License Number � �� <br />Med.j_ ca J, <br />Proppsod Use of guilding <br />Square Footage (If residential new constructfon, temodel or additian) <br />62 <br />Numb�r of de�ices (If low voltage) <br />Clty <br />Siate/Zlp phone <br />Y I7, 3?_0 <br />Contr ict Prtce of Work <br />J�r�r; l: S'l-.ebbins/Simpl�xG,ri.,nne:ll <br />Cont2�:t P.prson (Plan`Revlew) <br />bescriptlon of Work to 6a pone: Add ( 62 ) de�rices to existinq £i.xe �alarm .� stEm. JoinL- uen�ture <br />be'I,ween S�.znpJ.exGrinnEll & McI<inst,r.y Co. l:nc. <br />C1TY OF EVERE7'T I.OGAL SALES TAX COD� IS 3105 <br />/ her�by certffy that I heve r�ad and ex�min�d tl7iS applicafion end know #he samQ #o be true anri <br />cor�:ct. All provisions oflaws and arlir7anCms goveming tl�is type of work will be compJeted <br />whefher speciired herein or nof. The gr�nting of a pennif does not pr�5ume ta glv� authonty to <br />violat�e or canc�s! the prov/slons of any pther siate or /oca/ law regulat,r'ng Construction or tl�e <br />perfnnnance of canstruct/on. That I am authonzed by fhe owner of thls prop�rly fv perform fhe <br />work for whiCh applicaflon is mads and 1 comply with ihe Stete Confractors Law 98.27 RCW and <br />296.200 WAC. <br />Rr-v/S�ED 3i20H3 <br />FEE <br />� � � �� <br />PERMIT# <br />�l�0�-[3� <br />