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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> 3726 Broadway, Everett wa <br /> PROJECT ADDRESS <br /> Gateway surgery Ctr 3726 Broadway Everett 98201 4252360129 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Pacific Power Group 805 Broadway Street, # 700 Vancouver WA 98660 253-395-9077 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> EC PACI FPG867D7 047977 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> $500.00 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: 4 Hour load bank test of emergency standby <br /> generator. - 893529 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 J C q , <br /> /hereby certify that/have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That/am authorized by the owner of this property to perform the t <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Kacy Trojcak 03/27/2017 <br /> Signature Date <br /> REVISED 08/062014 <br />