916 PACIFIC AVE BASE FILE 2019-04-29

ELECTRICAL PERMIT APPLICATION v �ri- 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 www.everettwa.gov/permits PROJECT'SITE=INFORMATION • PROJECT ADDRESS: 916 PACIFIC AVENUE BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: providence - Pacific Hosp. • ELECTRICAL APPLICATION'INFORMATION CONTRACT PRICE OF WORK: $ 25 . each -1 5 NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES ® NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Performing (3)2 hour load bank tests of emergency standby generators. Providence - Pacific Campus #C.ONTACT=INFORMATION " OWNER NAME: Providence- Pacific Hosp. Parking Campus TENANT NAME(If Commercial): Providence OWNER MAILING ADDRESS: STREET 916 PACIFIC AVENUE Everett STATE wa ZIP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pacific Power Group CONTRACTOR ADDRESS: STREET 805 Broadway St Suite 700 ow Vancouver STATE wa ZIP 98660 CONTRACTOR PHONE: 2533263954 CONTRACTOR EMAIL: ktrojcak@pacificpowergroup.com CONTRACTOR LIC.#(REQUIRED): PACIFPG867D7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053000 PRIMARY CONTACT: ❑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 I have read and examined this application and know the same to be true and cbrrect. 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# 91,20r/S"- E 1 O -\9-0 • Herb zed Agent Signature Date (Revised 9/23/2016)