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<br /> _111����� ELECTRICAL PERMIT APPLICATION 4:
<br /> CITY OF EVERETT PERMIT SERVICES I.
<br /> 3200 CEDAR STREET,EVERETT, WA 98201
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<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www everettwa,gov/permits
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<br /> PROJECT ADDRESS: 1321 Colby Ave.
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<br /> BUILDING AREA(if residential,new construction,remodel,or addition)Addition SF i'
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: f I COMMERCIAL I.
<br /> USE OF BUILDING: Hospital .
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<br /> CONTRACT PRICE OF WORK:$ 5,934.63
<br /> NUMBER OF DEVICES(if low voltage): 24 1
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<br /> FIRE ALARM? ❑YES m NO
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable): j,
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<br /> DESCRIPTION OF WORK: Installation of 24 Cat6 data cables in OR 312 I
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<br /> OWNER NAME: TENANT NAME(If Commercial): Providence Health &Services
<br /> OWNER MAILING ADDRESS: STREET 1700 13th St
<br /> ,,TM Everett STATE WA zP 98201
<br /> OWNER PHONE: (425) 261 2000 OWNER EMAIL:
<br /> CONTRACTOR NAME: Pacific Communications Cabling
<br /> CONTRACTOR ADDRESS: STREET 10604 E. Riverside Dr. j
<br /> ,,Ty Bothell STATE WA zip 98011 ,
<br /> CONTRACTOR PHONE: (425)483 5957 CONTRACTOR EMAIL: administrator@pacificcc.com
<br /> CONTRACTOR LIC.#(REQUIRED): PAClFCC910L5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 035656 1
<br /> PRIMARY 0 CONTRACTOR 0 OTHER(Please Specify) 1
<br /> CONTACT: 0 OWNER
<br /> CONTACT NAME: CONTACT PHONE: (206)371 6714
<br /> Howard Ryder CONTACT EMAIL: howard@pacificcc.com
<br /> AGREEMENT:I hereby certify that 1 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 I I
<br /> comply with the State Contractors Law/a 27 RCW and 296.200 WAC.
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<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ---- -6-pariii,s1:2
<br /> ,G/•%7 E f Q -- Mie
<br /> Owner/Authorized Ag' t Sig ature Date (Revised 9/23/20W)
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