4201 RUCKER AVE COMMUNITY HEALTH CENTER 2019-04-10

4677. ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECTSITE INFORMATION r, PROJECT ADDRESS: 4201 Rucker Ave BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 10 COMMERCIAL USE OF BUILDING: / L TRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: 7,000.00 NUMBER OF DEVICES (if low v• tage): 37 FIRE ALARM? 0 YES ®NO ASSOCIATED BUILDING PERMIT • . icable): DESCRIPTION OF WORK: Installation of thirty-seven (37)thermostats. CONTACT INFORMATION OWNER NAME: Community Health Center of Snohomish County TENANT NAME(If Commercial): Community Health Center of Snohomish County OWNER MAILING ADDRESS: STREET 8609 Evergreen Way c,n, Everett STATE WA zip 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Evergreen Refrigeration CONTRACTOR ADDRESS: STREET 727 South Kenyon St. CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE: 206-763-1744 CONTRACTOR EMAIL: aleXb@evergreenhvac.com CONTRACTOR LIC.#(REQUIRED): EVERGRL882JB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044350 PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206-763-1744 Alex Burkhart CONTACT EMAIL: alexb@evergreenhvac.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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# $/i/((7 E Rcg - Owner/Authorized Agent Signature Date (Revised 9/23/2016)