4201 RUCKER AVE COMMUNITY HEALTH CENTER 2019-04-10

,0011P 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@everettwagov J www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4201 Rucker Avenue, Everett, WA 98203 BUILDING AREA(if residential, new construction,remodel,or addition)27,000 SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: Medical and Administrative Facility ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 102,227.17 NUMBER OF DEVICES(if low voltage); 479 FIRE ALARM? 0 YES 21 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Installation of Cat6 data/telephone, Cat3 telephone, and fiber optic cabling. CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial); CHC of Snohomish County OWNER MAILING ADDRESS: STREET 6609 Evergreen Way erry Everett sTATE WA ZIP 98208 OWNER PHONE: 425-789-3700 OWNER EMAIL: CONTRACTOR NAME: Structured Communications CONTRACTOR ADDRESS: STREET PO Box 1368 crry Snohomish STATE WA ZIP 98291 CONTRACTOR PHONE: 425-321-5343 CONTRACTOR EMAIL: dUetin.dUke@g0StrUCtUred.COM CONTRACTOR LIC.#(REQUIRED): STRUCC*89201_ CITY OF EVERETT BUSINESS LIC.CREQUIRED): 050586 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-357-3977 David Meyer CONTACT EMAIL:david.meyer@gostructured.com AGREEMENT:f hereby certify that I have read and examined this application and know the sa me to be true and coned Ali 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 ROW and 296.200 WAC. City of Everett Official Use Only ;t wner/Auth 'zed Agen Slgnatur Ca I 7 I o 2,0 PERMIT# E ot)1 (Revised 9/23/2016)