1700 13TH ST 2019-08-13 - Laserfiche WebLink

OLT ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 I (E)everetteps©everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1700 13TH STREET BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: Providence Colby Hosp 1 connection ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 500.00 NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES m NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Performing 4 hour load bank test of emergency standby generator. Providence Colby Hosp- 1901744 CONTACT INFORMATION OWNER NAME: Green House Data TENANT NAME(If Commercial): Providence Colby Hosp OWNER MAILING ADDRESS: STREET 1700 13TH STREET Cir EVERETT STATE wa ZIP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pacific Power Group CONTRACTOR ADDRESS: STREET 805 Broadway St Suite 700 crTy Vancouver STATE wa ZIP 98660 CONTRACTOR PHONE: 253-395-9077 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 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 /77 lam E 1,1 �Ow ized Agent �ie Date (Revised 9/23/2016)