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425-259-2794 11 p:46 a.m. 09-18-2017 2/3
<br /> 4577 ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 6133 LAKE CHAMPLAIN RD
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: IN COMMERCIAL
<br /> USE OF BUILDING: WATER FILTRATION PLANT
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<br /> CONTRACT PRICE OF WORK:$ 4000.00
<br /> NUMBER OF DEVICESjif low voltage):
<br /> FIRE ALARM? 0 YES Di NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):ADD ON TO EXISTING PERMIT E1709-103
<br /> DESCRIPTION OF WORK: ADD ON TO EXISTING SCOPE:
<br /> INSTALL(5) DUPLEX RECEPT, (2)QUAD RECEPTS, (1) UNDER COUNTER LIGHT
<br /> (1) LIGHT SWITCH AND (1) POWER POLE FROM CEILING TO ISLAND
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<br /> OWNER NAME: CITY OF EVERETT TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3002 WETMORE AVE
<br /> Circ EVERETT STATE WA zip 98201
<br /> OWNER PHONE: OWNER EMAIL: •
<br /> CONTRACTOR NAME: Seahurst Electric
<br /> CONTRACTOR ADDRESS: STREET 2915 Chestnut St
<br /> Cny Everett STATE WA ZJP 98201
<br /> CONTRACTOR PHONE: 425-258-1882 CONTRACTOR EMAIL: reception@seahurst.com
<br /> CONTRACTOR LIC.#(REQUIRED): SEAHUE1099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763
<br /> PRIMARY CONTACT: 0 OWNER Mg CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: Kim Smith CONTACT PHONE: 425-258-1882
<br /> PM -.JEFF HERRMANN 425-309-2554 CONTACT EMAIL: reception@seahurst.com
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws end 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 previsions 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
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> E E( .- 10
<br /> OvineifAuthoriiad Aasnt Signature Date (Revised 9/23/2016)
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