3802 BROADWAY B WESTERN WA MEDICAL GROUP 2017-01-13

� �- �LECTRICAL PERMIT A LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 9E201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFt3RMATiON PROJECT ADDRESS: 3802 Broadway #B Everett 98201 BUILDING AREA (if residential, new construction, remodel, or addition) 1500 SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: � COMMERCIAL USE OF BUILDING: MedlCal OffiCe ELECTRICAL APPLICATtON INFORMATION CONTRACT PRICE OF WORK: $ 2569.00 NUMBER OF DEVICES if low volta e: 45 FIRE ALARM? ❑ YES �NO ASSOCIATED BUILDING PERMIT # if a licable : DESCRIPTION OF WORK: Telecom - Data Only ' CONTACT INFORMATION OWNER NAME: TENANT NAME (If Commercial): Western WA Medical Group OWNER MAILING ADDRESS: sTrzee-r CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pacific Communications Cabling CONTRACTOR ADDRESS: sTReeT 10604 E. Riverside Dr. cnY Bothell STATE WA Z,P 98011 �._�s. CONTRACTOR PHONE: 425-483-5957 CONTRACTOR EMAIL: trina@pacificcc.com �� CONTRACTOR LIC. #(REQUIRED): PACIFCC910L5 CITY OF EVERETT BUSINESS LIC. #(REQUIR �): 035656 � PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) � CONTACT NAME: CONTACT PHONE: 425-483-5957 Katrina Nielsen CONTACT EMAIL: trlll8@pBCIfICCC.00171 — 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 pertorm the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. fC�#r'uui I�lU?-%�e-Y� 8/19/16 Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE �� PERMIT # E IC�o� — � �- Z (Revised 10/12/2015)