729 100TH ST SE WA STATE LABOR AND INDUSTRIES 2019-08-15

Oren- ECTRICAL PERMIT APSICATION 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 y PROJECTSITE INFORMATION PROJECT ADDRESS: 729 100th St SE 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: 0 COMMERCIAL USE OF BUILDING: Office Space ` LEC RICAL APPLICATION INFORMATION_' CONTRACT PRICE OF WORK. $ 8013.00 NUMBER OF DEVICES (if low voltage): 1 FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable): S ; DESCRIPTION OF WORK: Replacement of existing access cont I panel with newer panel. CONTACT INFORMATION. OWNER NAME: WA L&I TENANT NAME(If Commercial): Department of Labor and Industries OWNER MAILING ADDRESS: STREET PO Box 44836 CITY Olympia STATE WA ZIP 98504 OWNER PHONE: 360-902-6940 OWNER EMAIL: burw235@lni.wa.gov CONTRACTOR NAME: SKIDATA CONTRACTOR ADDRESS: STREET 1 Harvard Way Suite 5 CIN Hillsborough STATE NJ ZIP 08844 CONTRACTOR PHONE: 425-644-6884 ext 116 CONTRACTOR EMAIL: derek.ollom@skidata.com CONTRACTOR LIC.#(REQUIRED): SKIDAI*8470F CITY OF EVERETT BUSINESS LIC.#(REQUIRED 055981 PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-644-6884 ext 116 Derek M. OIIom CONTACT EMAIL: derek.ollom@skidata.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# Ow r/Authorized Agent Signature Date (Revised 9/23/2016)