1919 112TH ST SW 2019-08-20 - Laserfiche WebLink

OLT • t LEC3200TRICACEDAR L PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES VERETT, WA (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps©everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 91 9 112th St SW BUILDING AREA(if residential, new construction, remodel,or addition)0 SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: VI COMMERCIAL USE OF BUILDING: Nursing Home ''ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK$ 100. NUMBER OF DEVICES (if low v'Itage): 0 FIRE ALARM? Il YES �. ❑ NO ASSOCIATED BUILDING PERMIT# (if applicable): none DESCRIPTION OF WORK: Hooking UP Temp Generator , While we work on there Generator. nl5 4 r te: t ; :15 14�-� � .6 ,' �,.� a,�.�� i4 a /4 ci.„)' 1. CONTACT INFORMATION OWNER NAME: Everett Rehab and Medical TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1919 112 St SW C�Ty Everettyy STATE WAS zip 98204 OWNER PHONE: '_. 2,6 '' li 1 t OWNER EMAIL:. rt j n (C r f��.J td�-fpd a.ei',Ls;S ii a Cer� CONTRACTOR NAME: D SQUARE ENERGY SYSTEMS LLCCONTRACTOR ADDRESS: STREET201 W NORTH BEND WAY CITY NORTH BEND STATE WA Zip 98024---- CONTRACTOR PHONE: 425-888-2882 CONTRACTOR EMAIL: keithj@d2energy.com CONTRACTOR LIC.#(REQUIRED): (LAS uJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): aA 7f PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR 0 OTHER(Please Specify) \\ CONTACT NAME: CONTACT PHONE: 206-947-1535 h�� / KEITH JONES CONTACT EMAIL:keithj@d2energy.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Al/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# KEITH JONES x// , '. E . 5 Owner/Authorized Agent Signature .ate (Revised 9/23/2016) �-�Z