1604 BROADWAY H AND R BLOCK 2019-10-29

OLT ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 ( (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT'SIITE INFORMATION PROJECT ADDRESS: 1604-B Broadway Everett WA 98201 BUILDING AREA(if residential,new construction,remodel,or addition)1100 SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: Office Space ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 2,873.00 NUMBER OF DEVICES(if low voltage): 14 FIRE ALARM? D YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Installation of Cat 5E cabling to 14 faceplate locations for data/voice 5.. CONTACT NFATION OWNER NAME: H&R Block 1 NMT NAME(If Commercial): H&R Block OWNER MAILING ADDRESS: STREET 1604-B • CITY Everett :: .•.;''"L..... STATE WA LP 98201 OWNER PHONE: OWNER E.11 11IC:' CONTRACTOR NAME: System Tech CONTRACTOR ADDRESS; STREET 2816 N Madelia • CITY Spokane STATE WA zip 99207 CONTRACTOR PHONE: 206-491-6077 CONTRACTOR EMAIL: BAnderson@SystemTechWA.com CONTRACTOR LIC.#(REQUIRED): SYSTETW856OB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): a Receipt PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR L7 OTHER(Please Specify) CONTACT NAME: CONTACT PH101E: 253-347-3683 Herb Shrewsberry coNT¢►CT EMAIL:HShrewsberry@SystemTechWA.com AGREEMENT:I hereby certify that I have read and examined this application-and knoHgthe 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# t II 610 -to Owner/Authorized Agent Signature Date (Revised 9/23/2016)