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,.- ELECTRICAL PERMIT APPLICATION <br /> -J. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRUT, EVERETT,WA 96201 <br /> (P)425.257-8810 I FAX 425-257=8857 I (E) everettepseverettwa.gov I v, everettwa:govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5801: 23rd Druce West Suite#100 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR.OETAC IED 0 SFR-ATTACHED Q DUPLEX 0.MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> FUSE OF BUILDING: Public School <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 500 <br /> NUMBER OF DEVICES(if low voltage): I <br /> FIRE ALARM? lD YES Ca NCS` <br /> ASSOCIATED:BUILDING.PERMIT#(ifappiicabl.e): <br /> DESCRIPTION OF WORK: 2 hour!dad test on a::new installed standby generator <br /> CONTACT INFORMATION <br /> OWNER NAME:Wilson Pacific Elementary TENANT NAME(If,Commerci'I) <br /> OWNER MAILING ADDRESS:: STREET 5801 23rd Drive West Suite#100 <br /> cm, Everett STATE W f Ens 98203 <br /> OWNER PHONE: 208-510-0407 OWNER EMAIL: <br /> CONTRACTOR NAME: Cummins Inc <br /> CONTRACTOR ADDRESS: STREET 811 SW Grady Way <br /> ow Renton STATE WA SIR 98057 -- <br /> CONTRACTOR PHONE: 425-277-5343 CONTRACTOR EMAIL: dan.wassomlr cummins.Com \ <br /> CONTRACTOR LIC.#(REQUIRED): CL1NiM1I* 53C4 CITY OF EVERETT BUSINESS LIC.it(REGtUtrt <br /> r 9 <br /> / <br /> PRIMARY CONTACT: 0 OWNER' d CONTRACTOR 0 OTHER(Please.Specify).. <br /> CONTACT NAME; CONTACT PHONE: 425-277.5343< / <br /> Dan Wassom CONTACT EMAIL:Dan.wassom a@cuinminS:com <br /> AGREEMENT:I hereby certile that!'have read and examined this:application;and know the sante to he 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;provitions of any-other slate or <br /> local law regulating.construction or the performance of construction Platt em authorized by the owner of this propertyy to perform the'work for which application is made and t <br /> comply with the State Contractors taw la 27 RCW and 296.200 WAC <br /> City of Everett Official ties Only. <br /> PERMIT#' <br /> (172 L\-I 5/2-,6e/1/7 E 1 S - ' <br /> OwnWriAuthorized.Agennt Signature Date (Revised 912320/6) <br />