6133 LAKE CHAPLAIN RD 2019-02-11

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 4E77 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6133 LAKE CHAPLAIN ROAD BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ®COMMERCIAL USE OF BUILDING: City of Everett water filtration Plant ELECTRICAL;.APPLI A"TION:INFORRMATION CONTRACT PRICE OF WORK: $ 250.00 each NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES 17J NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Performing (3)2 hour load bank tests of emergency standby generators. City of Everett Water Filtration CONTACT INFORMATION OWNER NAME: City of Everett TENANT NAME(If Commercial): City of Everett OWNER MAILING ADDRESS: STREET 6133 LAKE CHAPLAIN ROAD cnv Monroe STATE wa ZIP 98272 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pacific Power Group CONTRACTOR ADDRESS: STREET 805 Broadway St Suite 700 cm Vancouver STATE wa zP 98660 CONTRACTOR PHONE: 2533263954 CONTRACTOR EMAIL: ktrojcak@pacificpowergroup.com CONTRACTOR LIC.#(REQUIRED): PACIFPG867D7 ,CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053000 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-395-9077 AMANDA NOKES CONTACT EMAIL: KTROJCAK@PACIFICPOWERGROUP.COM AGREEMENT:I hereby certify that!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!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# ner/A orized Agent Signature Date (Revised 9/23/2016)