15 SW EVERETT MALL WAY FUNCTIONAL HEALTH CONSULTING 2018-05-29

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: 15 SW Everett Mall Way Everett WA. 98204 BUILDING AREA(if residential, new construction, remodel, or addition)5443 SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ® COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 67,027.00 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ® NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: Tenant improvements for clinic CONTACT INFORMATION OWNER NAME: Rosen Bel-Kirk Associates, LLC TENANT NAME(if Commercial): Functional Health Consulting, LLC OWNER MAILING ADDRESS: STREET Rosen Properties, PO Box 5003 CITY Bellevue STATE WA ZIP 98009 OWNER PHONE: 425-289-2234 OWNER EMAIL: vicky@rosenproperties.com CONTRACTOR NAME: H&M Electric, INC. CONTRACTOR ADDRESS: STREET PO BOX 799 CITY Marysvville STATE WA zIP 98270 CONTRACTOR PHONE: 360-658-0501 CONTRACTOR EMAIL: justinm@hmelec.com CONTRACTOR LIC.#(REQUIRED): HMELEI'077KR CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 039193 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-658-0501 Justin McCann CONTACT EMAIL:justinm@hmelec.com AGREEMENT.I 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 perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# JUVXL*11MGCCLYL41t 9.29.2016 EyLpM- MI Owner/Authorized Agent Signature Date (Revised 9/23/2016)