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425-355-1610 29:22 a.m. 08-21-2017 2/2 <br /> 4rE77 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ;,._, ROJECT.SIITE INFORMATION <br /> PROJECT ADDRESS: 4201 Rucker Avenue <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Medical <br /> ................. <br /> O <br /> CONTRACT PRICE OF WORK:$ 304,503 <br /> NUMBER OF DEVICES(if low voltage): 62 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1705-065 <br /> DESCRIPTION OF WORK: New Medical Building <br /> CONTACT.INFORM <br /> OWNER NAME:Community Health Center of Sno. Co. TENANT NAME(If Commercial): Same <br /> OWNER MAILING ADDRESS: srREEr 8609 Evergreen Way <br /> cr,„ 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 /> crrr Lynnwood STATE WA <br /> ZIP 98087 <br /> CONTRACTOR PHONE: 428-347-7600 CONTRACTOR EMAIL: info@duttonelectric.com <br /> CONTRACTOR LIC.#(REQUIRED): DUTTOEC137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):019811 <br /> PRIMARY CONTACT: 0 OWNER QJ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-330-3562 <br /> Mike Carlson CONTACT EMAIL:info@duttonelctric.com <br /> AGREEMENT:I hereby certify that!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 16.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .ice• i1/AZi /i E n of_ 11n <br /> �wnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br />