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425-355-1610 1 16 a.m. 06-21-2017 2/2
<br /> ELECTRICAL PERMIT APPLICATION
<br /> Iw►� CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 J FAX 425-257-8857 1 (E)everetteps©everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 01 Rucker Avenue
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: Medical
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<br /> CONTRACT PRICE OF WORK: $ Op 0,®f
<br /> NUMBER OF DEVICES(If low voltage):
<br /> FIRE ALARM? ❑YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: TEMPORARY POWER
<br /> �:SCO
<br /> >�._.' -� . �,.. __STACVNNRMAT!
<br /> OWNER NAME: Community Health Center of Sno. Co. TENANT NAME(If Commercial): Same
<br /> OWNER MAILING ADDRESS: STREET 8609 Evergreen Way
<br /> cnr Everett STATE WA zip 98208
<br /> OWNER PHONE: 425-789-3700 OWNER EMAIL:
<br /> CONTRACTOR NAME: Dutton Electric Company, Inc.
<br /> CONTRACTOR ADDRESS: STREET 12407 Mukilteo Speedway, A170
<br /> CITY Lynnwood STATE WA Zjp 98087
<br /> CONTRACTOR PHONE: 428-347-7600 CONTRACTOR EMAIL: info@duttonelectric.com
<br /> CONTRACTOR LIC.#(REQUIRED): DUTTOEC137P3 CITY OF EVERETT BUSINESS UC.#(REQUIRED):019811
<br /> PRIMARY CONTACT: 0 OWNER l CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-409-4854
<br /> Brad Morin CONTACT EMAIL:info@duttonelctric.com
<br /> 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
<br /> 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
<br /> 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 I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. -'
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> III 416 Ari E I1 D [SO
<br /> Owner/Authorized Agent Signature Date
<br /> (Revised 9/23/2016)
<br />
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