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425-259-2794 0L.33:52 p.m. 07-13-2016 2/2 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> 3327 Colby <br /> PROJECT ADDRESS <br /> Northsound Dermatology same <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Seahurst Electric 2915 Chestnut St Everett WA/98201 425-258-1882 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> SF-AHUE1099QN 18763 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Med Clinic 500.00 <br /> Proposed Use of BuildingCgOnnOntVrVicyo419-'h8-4320 <br /> . <br /> jnovy@seahurst.com <br /> Square Footage(if residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of wort[to Be Done: Install new disconnect and me for heat pump <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that/have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E t " 0 7-- 9 <br /> a <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 0 l <br /> 296.200 WAC. <br /> dD --7s ^ <br /> gnature I Date <br /> REVISED OVOE/2014 <br />