1005 PACIFIC AVE 2017-09-18 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PR�JECT SITE INFQRMATIQN PRo�Ecr ao�REss: 1019 Pacific Avenue Everett, WA 98201 BUILDING AREA(if residential, new construction, remodel, or addition) PS Kidney Center SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL USE OF BUILDING: �Ia�ySIS C@I1teC ELECTRICAL APPLICATION INFORMATlON CONTRACT PRICE OF WORK: $ $74,804.81 NUMBER OF DEVICES if low volta e : FIRE ALARM? ❑YES m NO ASSOCIATED BUILDING PERMIT# if a licable : DESCRIPTION OF WORK: installation of cable and nurse call devices (I v Itage) contracted direct through owner in two phases. This ermit is for hase 1 and will involve the installatio of 24 atient stations and their associated dome li hts, etc. CtiNTACT INF�RMATION OWNER NAME: PUg2t SOUIId KIdl12y C2fltef TENANT NAME(If Commercial): Attl1: MBfv SChlepp OWNER MAILING ADDRESS: sTReEr 1019 Pacific Avenue �,n Everett STATE WA Z,P 98201 owNeR PHONe: 360-454-5280 ext 110 OWNER EMAIL: �'1afVS.Cbt@pSICC.fI@t coNTwacTOR NamE: ATS Facility System CONTRACTOR ADDRESS: sTReer 690 N. Meridian Street �„-,, Kalispell STATE MT Z,P 59904 CONTRACTOR PHONE: 406-752-4033 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUtRED): ATSFAFSS51 CD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR C!7 OTHER(Please Specify) Project Manaaer for ATS CONTACT NAME: CONTACT PHONE: 206-473-9274 Krista Shulman CONTACT EMAIL: kShUlfTl811 U�BtSfSI.COf11 AGREEMENT:1 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 pertormance of construction. That 1 am authorized by the owner of this property fo perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. City of Everett Official Use Only PERMIT# Digitally signed by Krista Shulman �� K r i s t a S h u I m a n DN rn=Kris[a 5hulman,o,ou,email=kshulman(roatsfsi mm, � A _ Q c=US ` Date�.7016.7 2.D5 07:44�33-08'00' Owner/Authorized Agent Signature Date (Revised 9/23/2016)