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LECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 477- <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps©everettwa.gov i www.everettwa.gov/permits <br /> PRGJECT MITE INFORMATION I <br /> PROJECT ADDRESS: 3726 Colby Ave <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: I$COMMERCIAL <br /> USE OF BUILDING: Medical Bldg. <br /> ELEC'�"ft CALAPP 1 T ONINFORMATION <br /> CONTRACT PRICE OF WORK: $ 437.00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES BD NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Extend a circuit at the Skin Surgery <br /> Job 18CC <br /> `'rF" j." CdiINtACT1ORMA'TIN "Q, � . <br /> OWNER NAME: The Everett Clinic TENANT NAME(If Commercial): The Everett Clinic <br /> OWNER MAILING ADDRESS: STREET 3901 Hoyt Avenue <br /> CITY Everett STATE WA zip 98201 <br /> OWNER PHONE: 425-259-0966 OWNER EMAIL: N/A <br /> CONTRACTOR NAME: Dutton Electric Company, Inc. <br /> CONTRACTOR ADDRESS: STREET 12407 Mukilteo Speedway, A-170 <br /> CITY f.ynnwnnd STATE W A zi 98087 <br /> CONTRACTOR PHONE:(425) 347-7600 CONTRACTOR EMAIL: infoCTduttonelectric.com <br /> CONTRACTOR LIC.#(REQUIRED): DUTTOECI37P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):019811 <br /> PRIMARY CONTACT: 0 OWNER 4 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Brad Morin CONTACT PHONE: 425-409-4854 <br /> CONTACT EMAIL: brad(iduttonelectric.com <br /> AGREEMENT:T 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 <br /> 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 <br /> 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> s .� C <br /> signee lry Pelta Smilh PERMIT# <br /> . eda�duttonelestri�.xam,OU:', <br /> 0-OECD,CN.PeitePa to the accuracy ana inwg by at min document <br /> 05 1018.534M E `Q / 1 _-0(-4 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />