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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> ... , . � ,::.�: � <br /> , <br /> �t��a .y�, r4Y a.S�.<.�w�.. <br /> PROJECT ADDRESS: S4O N. BROADWAY BLDG B EVERETT, WA 98204 <br /> BUILDING AREA(if residential,new construction,remodel,or addition)5000 SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> use oF Bu��o�N�: DSHS DDA N EVERETT PH2 J# 511997 <br /> , � . .,�.,.t v ti <br /> ,�"�'^'3 5q� ^� � <br /> . � �� M'�� �,� �� 'i ���� � <br /> a�.. <br /> CONTRACT PRICE OF WORK:$ 7500.00 <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF WORK: PROVIDE LABOR & MATERIALS TO INSTALL CAT5E CABLING TO (35) <br /> WORK STATIONS, APPROX 5000 SQ FT. <br /> � ..-,�� n_ .." �,�'l��'... ..�,r�.:•,. a a .:Y: ._:::-- :: � .t�i .. F.� �,,.; � .✓� <br /> . � ' :--. „ . � %%'� -� ' _..: <br /> s � � <br /> - � .^P^�r.- s . �,:,�;�r a ,�,a�., - �.�d r:,,�`,' �z'.�k�, �S <br /> OWNER NAME:DSHS TENANT NAME If Commercial : DSHS <br /> OWNER MAILING ADDRESS: s�eer$40 N BROADWAY <br /> �,TM EVERETT ST,,r�WA Z,P 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: COCHRAN INC. (J#511997) <br /> CONTRACTOR ADDRESS: srneer 12500 AURORA AVE N <br /> cin•SEATTLE srn�WA ziP 98133 <br /> CONTRACTOR PHONE:2OC-446-8104 coNrRacTOR enna�: KIM.ZINTER@COCHRANINC.COM <br /> CONTRACTOR LIC.#(REQUIRED): COCHRI*OS$.JS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): I9558 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-t�t�6-$��,Q, <br /> DON PITTMAN coNTacreMa�:AHOPKINS@COCHRANINC.COM <br /> AGREEMENT.•I hereby certily that I have read and examined this application and know the same to be true and correct. All provisions of laws and wdinances goveming this type <br /> of work will be completed whether spec�ed 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 regu/ating construction w the perfamance of construction. That 1 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 18.27 RCW and 296.200 WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> Kim Zinter '"81Q0e°'YpmZ'°,e' <br /> N =US,E=1alMer�daeaimpllfleC.com,O=DA$31mplitletl,CN�Kim ZJr2ar C� Q�6 ��� `3� <br /> :Y018.03.1808:38:140T00' r <br /> � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016J <br />