3901 HOYT AVE EVERETT CLINIC OPHTHALMOLOGY 2019-09-20

Nov. 13 . 2015 01 : 08 PM Structured Communications 4253215735 PAGE. 1 • 0477- ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3901 Hoyt Ave, Everett,WA 98201 BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: Il COMMERCIAL USE OF BUILDING: Clinic ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 7,634 NUMBER OF DEVICES (if low voltage): 40 FIRE ALARM? 0 YES I%1 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Main Level Founders-Ophthalmology TI -Voice/data cabling and paging speakers CONTACT INFORMATION OWNER NAME: The Everett Clinic TENANT NAME(If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET 3901 Hoyt Ave cn-y Everett STATE WA ZIP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Structured Communications CONTRACTOR ADDRESS: STREET PO Box 1368 CITY Snohomish STATE WA ZIP 98291 CONTRACTOR PHONE: 425-321-5343 CONTRACTOR EMAIL: dustin.duke@gostructured.com CONTRACTOR LIC.#(REQUIRED): STRUCC*8920L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 050586 PRIMARY CONTACT: D OWNER Ii CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-321-5343 Dustin Duke CONTACT EMAIL: dustin.duke @gostructured.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 specked 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 1A; OD PERMIT# I V:1,11/r 0 er/Author-. d Agent Signatu e Date (Revised 10/122015)