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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, F_VERETT, WA 98201 /Dv��i Z <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> E / 2/D-!l5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PROVIDENCE MEOICAL GROUP MILL CREEK CLINIC 12800 BOTHELL EVERETT HWY <br /> PROJECT ADDRESS <br /> PROVIDENCE MEDICAL GROUP MILL CREEK CIINIC 12800 BOTHELL[VERETT HVJY,EVER[T"!,YVA 425-J16S000 <br /> Owner Mait AAdress Cily State2ip Phane <br /> PROVIDENCE MEDICAL GROUP MILL GREEK CLiNIC 12800 BOTHELL EVERETT HWY,EVERETT,Wn 425-316�5400 <br /> Tenanl Mail Address City Slate/Zip Phone <br /> VF.Ch ElecC:ic PO RO;{ y0467 SeacClr 'r7N 'i810ti 206-43ti-5200 <br /> Electncal Contractor Mail Address Ci1y State/Zip Phone <br /> V6CAF.0 ISA 2t�fU 81.200 <br /> Slale License Number Contract Price of Work <br /> COMh1ERCI�L�dEDICAL N�NCY DUMONT <br /> Proposed Use ol Building Conlacl Person (Plan Review) <br /> Descriptian o1 VF'ork to 8c Done: ND R11984�DD 121 nUTLE75 W 2ND FLOOR IOF _ <br /> NOTE: WIRING IIJ NON-DWELLINGS IS REOUIRED TO FEE <br /> BE IN RAC[WAYS. MC OR nC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cehi/y Ihal I have re�d and examined this applicafion and know fhe same lo be frue and ��21 t� -- i I S <br /> correcl. All provisions ollaws and orduianr.es 9overnrng Ihis type oI work wdl be r.omplr,led <br /> whefhcr spr.r.ilied hercin or not. fhe �ran(ing ol a permd docs nol presumc fo give aulhnrdy fo <br /> violate o�c�ncr.l fhe provisions ol any olher state or local law�equlaling conslruclion or(he <br /> perlorrnance ol cunshuclion. Thal I arn authorized by lhe owner o�lhrs propedy 10 pe�lorm the <br /> work!or which applica(ion is madc end 1 r.ompty wdf� fhr. Slate Confraclo�s Law 18.21 RCW and <br /> 296.200 WAC. <br /> �(ERI UnviS t DI t7l t7 <br /> Sign:tlurc Dnte -'-- <br />