1320 COLBY AVE PRMC 2017-04-10 - Laserfiche WebLink

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 I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1320 Colby Ave BUILDING AREA(if residential, new construction, remodel, or addition)3200 SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ® COMMERCIAL [USEF BUILDING: hospital ELECTRIN AM.APPLICATION INFORMATION E CONTRACT PRICE OF WORK: $ 2590 NUMBER OF DEVICES (if low voltage): 30 FIRE ALARM? ❑YES m NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Install 30 CAT 6 plenum rated cables from IDF to 3rd floor - 6 pre-op rooms CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): Providence Medical Center OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pacific Communications Cabling CONTRACTOR ADDRESS: STREET 10604 E. Riverside Dr CITY Bothell STATE WA ZIP 98011 CONTRACTOR PHONE: 425-483-5957 CONTRACTOR EMAIL: trina@pacificcc.com CONTRACTOR LIC.#(REQUIRED): PACIFCC91 01_5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 035656 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-770-5740 Dave Baker CONTACT EMAIL: AGREEMENT.1 hereby certify that/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 perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# rca.�ruw, uta 12/15/16 E UA 2 - V� 2� I Owner/Authorized Agent Signature Date (Revised 9/23/2016)