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1 <br /> I <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT <br /> '"� ?EINMA"rION <br /> PROJECT ADDRESS x 4 a <br /> BUILDING AREA(if residential,new taction;remodel,orae ditI ) 15Si <br /> I --. SF. <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> 1 <br /> ELECTRICAL APPUCATiON INFORMATION <br /> CONTRACT PRICE OF WORK:$1 ,2,3 J <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 14YES 0 NO .. <br /> ASSOCIATED BUILDING PERMIT#(if applicable);_ <br /> DESCRIPTION OF WORK: <br /> I <br /> E., S <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Ridge <br /> TENANT NAME elf 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 /> cm Covington STATE WA ZIP 98042 <br /> CONTRACTOR PHONE:253-631-7750 X 1028 CONTRACTOR EMAIL: permits@providentelectric.net <br /> CONTRACTOR LIC.#(REQUI D): PROVIEI103C2 CITY OF EVERETT BUSINESS LIC. REQUIRED):043329 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-631-7750 x 1028 <br /> Shannon Chelette CONTACT EMAIL: <br /> permitsqprovidentelectric.net <br /> 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 <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 I am authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i'I Ilii- E 1 -vc4 —I Co <br /> Owner/Authorized Agent Signature Date (Revised 9/2312016) <br />