5839 HIGHWAY PL 2019-01-18 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 74,11Ir- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT STEINFORMATION PROJECT ADDRESS: 5Gi I-1I A t t :d� BUILDING AREA(if residential,new '$ ' con,remodel,or addition)____ISS7 SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$123 tD NUMBER OF DEVICES(if low voltage):_ FIRE ALARM? _ beYES ❑NO ASSOCIATED BUILDING PERMIT#(ifapplicable): DESCRIPTION OF WORK: /J ,(A) 100 AMP 5FP1 CONTACT INFORMATION OWNER NAME:Pacific Ridge TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 21300 Victory BLVD STE 700 c,,Woodland Hills STATE CA ZIP 91367 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Provident Electric Inc CONTRACTOR ADDRESS: STREET PO Box 7087 Covington STATE WA ZIP 98042 CONTRACTOR PHONE:253-631-7750 x 1028 1CONTRACTOR EMAIL: permits@providentelectricnet #( PROVIEl103C2 ct�NTRACTOR LIC. REQUtROJzGi'I"Y OF EVERETT BUSINESS LIC.#(FtEQUtR ):043329 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME:, CONTACT PHONE: 253-631-7750 x 1028 Shannon Chelette CONTACT EMAIL:permits@providentelectric.net 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 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# E k, .);;;;LIAC),\A"•.—..-r 0• (117-7117 Owner/Authorized Agent Signature Date (Revised 9/23/2016)