15 SW EVERETT MALL WAY EDWARD JONES 2018-05-29

ELECTRICAL PERMIT APRLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFQRM/�fi�ON ' �Ro�ecT AooREss: 15 SW EVERETT MALL WAY, STE G&H SUILOING AREA(if residential, new construction,remodel, or addition)6000 SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL use oF Bui�oiN�: HEALTH CLINIC ELECTRtGAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: � 41,342 NUMBER OF DEVICES ii tow volta e : 3 LOW VOLTAGE THERMOSTATS FIRE ALARM? ❑YES 0 NO ASSOCIATED BUILDING PERMIT# if a licable : CONSTRUCTION PERMIT#M1610-023 DESCRIPTION OF WORK: INSTALLATION OF 3 LOW VOLTAGE THERMOSTATS AND ASSOCIATED WIRING. COWTACT It�MFORMATIO� OWNER NAME: ROSEN-BEL-KIRK AS50CIATES TENANT NAME If Commercial : VIDA HEALTH OWNER MAiLING ADDRESS: sTReer PO BOX 500 c,n, BELLEVUE STATE WA z,P 98009 OWN�F2 PHONE: OWNER EMAIL: CONTRACTOR NAME: EMERALD AIRE, INC CONTRACTOR ADDRESS: srReer 5108 D ST NW ciTy AUBURN srnre WA ziP 980 ��~� CONTRACTOR PHONE: 253-872-5665 CONTRACTOR EMAI�: PERMITS@EMERALDAIRE.COM '�` Ct3NTRACTOR LIC.i�{{REf1tlIREt7): EMERAAI991 KG CiTY OF EVERETT BU5INESS LIC.#(REQUtREDa;;'022819 y PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑OTHER(Please 5pecify) �° CONTACT NAME: CONTACT PHONE: 253-872-5665 � Mlt'aflda MBtldeZ CONTACT EMAIL: pERMITS@EMERALDAIRE.COM AGREEMENT.•I hereby certify that I have read and examined this application and know the same to be true and correct. AI!provisions of laws and ordinances goveming this type of work wif!be completed whether speciiled herein or not. The granting of a permif does not presume to give authority to violate or cancel lhe provisions of any other state or local law regulating construction o�the pertormance of construcfion. That I am authorized by the owner of this pioperty to per(orm the work for which application is made and 1 comply wifh fhe State Contractors Law 18.17 RCW and 296.200 WAC. � City of Everett Official Use Only PERMIT# � // l� ZO/(p � � -- � �-E `� Ow�erlAuthorized Agent Slgnature Date (Revised 9/23/2016)