906 SE EVERETT MALL WAY FRONTIER COMMUNICATIONS 2021-11-02

elm LECTRICAL PERMIT APPLPATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits ;,. ;: PROJECT SITE INFORMATION PROJECT ADDRESS: 906 SE Everett Mall Way, Suite 500 BUILDING AREA: N/A sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL t,Az ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK: CONTRACT PRICE OF WORK:$ 44,150.00 ASSOCIATED BUILDING PERMIT#(if applicable N/A ) DESCRIBE SCOPE OF WORK: 200) - ®2IS Relocate lighting, power to furniture, add TV outlets, relocate switching. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:10 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑✓ Other(List All):Raceways only for L.v.Systems. t ODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑YES--See Below&Pg.2 ❑ oy tchhis cakpp icthaitsi obno x(,s Ie aem etxat tipag teh)a,tA I NhDa vPl read eavdew u insd eOT nredq aluil roefd WbeAcCa u2s9e6-4 Im6Beet9 0al0l,osf etlheec edlwen gs pec ifsiec rteass on aot nd oagoe 2 See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO EYES-See Below&Pg. 3 ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION- ' 4,7 ;, OWNER NAME: Frontier TENANT BUSINESS NAME(If Commercial): Frontier OWNER MAILING ADDRESS: STREET 906 SE Everett Mall Way, Suite 500 (� fj CITY Everett STATE WA ZIP 98208 OWNER PHONE:N/A OWNER EMAIL:N/A CONTRACTOR NAME: Seahurst Electric, Inc. CONTRACTOR ADDRESS: sTREET2915 Chestnut St. CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL:dleblanC@SeahUrst.Com CONTRACTOR LIC.#(REQUIRED):SEAHUE1099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 PRIMARY CONTACT: 'DOWNER ['CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425) 258-5143 Dave LeBlanc CONTACT EMAIL:dleblanc@seahurst.com 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 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 PERMI,TI OpMhcgnetl by OwbJ.LeBbnc - E ( �I - DN O•US E•tllebbncmewbunLcom O•Se.bom J. I LV3 David J LeBlanc Eb Inc',OU•FE(Fropct Enp nee�CN•DevNJ 1-21-20 Da :302001.Z110<)'.3&OB'00' OvIner/Authorized Agent Signature Date (Revised 1111/2019) Page 1-Application