5841 HIGHWAY PL 2019-01-18 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION ;:- 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 SITE INFORMATION PROJECT ADDRESS: -„,o7 1 rit BUILDING AREA(if residential,new co action,remodel,or addition' __15/%1 SF BUILDING TYPE: 0 SFR-DETACHED 21 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION. CONTRACT PRICE OF WORK: NUMBER OF DEVICES(if low voltage): FIRE ALARM? RYES ❑NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Nett) JD°AMP SF i CONTACT INFORMATION OWNER NAME:Pacific Ridge TENANT,NAME(If Commercial): OWNER;MAILING.:ADDRESS: STREET 21300 Victory BLVD STE 700 ,QTY Woodland Hills STATE CA ZIP 91367 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Provident Electric Inc 'CONTRACTOR ADDRESS: STREET PO Box 7087 c,,Covington STATE WA ZIP 98042 :CONTRACTOR PHONE:253-631-7750 x 1028 'CONTRACTOR EMAIL: permits@providentelectric.net CONTRACTOR LIC.#(REQUIRED): PROVIEl103C2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)043329 'PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify), CONTACT NAME: COACT PHONE: 253-631-7750 x 1028 Shannon Chelette CONTACT EMAIL: rrnits97a prow dentelectric.net AGREEMENT:I 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 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 RC W and 296.200 WAC. City of Everett Official Use Only PERMIT# `f E 4 - a Owner/Authorized Agent Signature Data (Revised 9/23/2016)