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1 <br /> I <br /> ELECTRICAL PERMIT APPLICATION <br /> p .> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> 4 PROJECTSIllt IN . , <br /> PROJECT ADDRESS >i <br /> BUILDING AREA(if residential,new canstra iop,remodel,or addition)„ inn SF_, <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$" I Z% j <br /> NUMBER OF DEVICES if low voita0 e <br /> FIRE ALARM? ;S'ES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable). <br /> DESCRIPTION OF WORK: , Ar , 1 i A,. ra 3 '• <br /> - (1)._, , ,) , C) —O j <br /> CONTACT INFORMATION <br /> OWNER NAME Pacific Ridge TENANT NAME iI1<commercial): <br /> OWNER MAILING.ADDRESS: STREET 21300 Victory BLVD STE 700 <br /> CITY Woodland Hills STATE CA ZIP 91367 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Provident Electric Inc <br /> CONTRACTOR ADDRESS: STREET PO Box 7087 <br /> CITY Covington „„ STATE WA <br /> ZAP 98042 <br /> «$:NTRACTOR PHONE:253-631-7750 x 1028 CONTRACTOR EMAIL; pennits@providentelectric.net <br /> CONTRACTOR LIC. QUIRED PROVIEI I03C2 CITY OF EVERETT BUSINESS LIC. REOUIRErd:043329 <br /> PRIMARY CONTACT: 0 OWNER fa CONTRACTOR 0 OTHER(Please Specify). <br /> CONTACT NAME: CONTACT PHONE: 253-631-7750 x 1028 <br /> Shannon Chelette CONTACT EMAIL: errnits .rovidentelectric.net <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be 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 provisions of any other state or <br /> local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 298,200 WAC. <br /> City of Everett Official Use Only <br /> '! PERMIT# <br /> 92/11:10,14,. (Iko$&---* X27/ii E fl- t43 <br /> Owner/Authorized Agent Signature Dal <br /> (Revised 9%23/2016) <br />