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0477.' 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 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1321 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: 0 COMMERCIAL <br /> USE OF BUILDING: HOSPITAL <br /> • ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 11745 <br /> NUMBER OF DEVICES(if low voltage): 9 <br /> FIRE ALARM? m YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Add (9)devices for electrical room update,A-Wing. Will tie in to existing fire alarm system. <br /> Joint venture between SimplexGrinnell and Veca Electric. <br /> CONTACT INFORMATION <br /> OWNER NAME:Providence Regional Medical Center TENANT NAME(If Commercial): Providence Regional Medical Center <br /> OWNER MAILING ADDRESS: STREET 1321 Colby Ave, Colby Campuy <br /> „Ts, Everett STATE WA Zip 98201 <br /> OWNER PHONE: 425-404-5000 OWNER EMAIL: <br /> CONTRACTOR NAME: SimplexGrinnell <br /> CONTRACTOR ADDRESS: STREET 9520 10th Ave S. Suite 100 <br /> ciry Seattle STATE WA zip 98108 <br /> CONTRACTOR PHONE: 206-291-1400 CONTRACTOR EMAIL: jastebbins@simplexgrinnell.com <br /> CONTRACTOR LIC.#(REQUIRED): SIMPLL*981 SG CITY OF EVERETT BUSINESS LIC.#{REQUIRED): 050211 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-291-1468 <br /> Janet Stebbins/Permit CONTACT EMAIL:jastebbins@simplexgrinnell.com <br /> AGREEMENT::1 hereby certify that l 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 property to perform the work for which application is made and <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> „ {' Stebbins Digitally signed by Janet Stebbins PERMIT# <br /> J a n e` S b b i 1 1 S ON:;inie net Stebbins,o�impleaGrinnell, E L ©� - D 7 <br /> ou=Electronics Operations, %��)�/) <br /> Date21708 i01 55639-0inneltcom, US 01 r <br /> Dale:2017.08301 s:s&39-0T00' <br /> Owner/Authorized Agent Signature to (Revised 9/23/2016) <br />