1100 PACIFIC AVE EVERETT BONE AND JOINT 2018-12-14

425-259-2794 0 09 p.m. 09-20-2017 2/2 071E77- ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 [ (E)everetteps@everettwa.gov I www.everettwa.gov/permits E E ETT QN QLWT PROJECT SITE INFORMATION'}..___.. ...: PROJECT ADDRESS: 1100 PACIFIC AVE SUITE 100 BUILDING AREA(If residential,new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: PROLIANCE SURGEONS DOCTORS OFFICE ' ECTRI A1,1- , PI-1G�.#VON .NFIDRMAT.ON" [_..- } "` . .. fel.. :�. :_mss....__ _- t ...._:.a .�....... .._ ...... _ ,.u.._ _ ..:..u._ . :;5 4 i CONTRACT PRICE OF WORK: $ !• 1500.00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES ASSOCIATED BUILDING PERMIT#(if applicable): NA DESCRIPTION OF WORK: INSTALL (4) DROP CORD RECEPTACLES & (1) COMPUTER RECEPTACLE CUT IN CONTaA,C' INFORMATION OWNER NAME: PROLIANCE SURGEONS TENANT NAME(If Commercial): EVERETT BONE &JOINT OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Seahurst Electric CONTRACTOR ADDRESS: STREET 2915 Chestnut St CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE: 425-258-1882 CONTRACTOR EMAIL: reCeptiOn@seahurst.com CONTRACTOR LIC.#(REQUIRED): SEAHUE1O99QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 PRIMARY CONTACT: 0 OWNER IX CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: Kim Smith CONTACT PHONE: 425-258-1882 PM -JON NOVY 425-508-4320 CONTACT EMAIL: reception@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 slate or local law regulating construction or the performance of construction. That l am authorized by the owner/Jr/his property to perform the work for which application is made and! comply with the State Contractors Law 10.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# I / E (pg Owner/AuthorizedAgi3nt Signature Date (Revised 9/23/2016)