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425-259-2794 �.16:51 a.m. 01-23-2018 2/2
<br /> I
<br /> ELECTRICAL PERMIT APPLICATION
<br /> ^I y CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 j (E) everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 1100 PACIFIC AVE
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: D SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: COMMERCIAL MEDICAL OFFICES
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<br /> CONTRACT PRICE OF WORK: $ 900.
<br /> NUMBER OF DEVICES(if low volt-•e): NA
<br /> FIRE ALARM? 0 YES IN NO
<br /> ASSOCIATED BUILDING PERMIT# cable): NA
<br /> DESCRIPTION OF WORK:EXTEND EXISTING 20AMP CIRCUIT FOR NEW MAIN LOBBY ENTRY DOOR OPENER
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<br /> OWNER NAME: TENANT NAME(If Commercial): EVERETT BONE &JOINT
<br /> OWNER MAILING ADDRESS: STREET
<br /> Clio STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Seahurst Electric
<br /> CONTRACTOR ADDRESS: STREET 2915 Chestnut St
<br /> cm, Everett BTATE WA ZIP 98201
<br /> CONTRACTOR PHONE: 425-258-1882 CONTRACTOR EMAIL: reception©seahurst.com _
<br /> CONTRACTOR UC.#(REQUIRED): SEAHUE1099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRE : 18763
<br /> PRIMARY CONTACT: El OWNER Da CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: Kim Smith CONTACT PHONE: 425-258-1882
<br /> CONTACT EMAIL: reception@seahurst.com
<br /> AGREEMENT:I hereby cartify that I have mad end examined this application and know the same to be hue and correct. All provisions of laws and 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 pm visions of any other stale or
<br /> local law regulating construction or the performance of construction. That lam 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 16.27 RCW and 296.200 WAG.
<br /> City of Everett Official Use Only
<br /> PERMIT
<br /> /-,33 E tc2a -1 (oLi
<br /> Own r/Authorize A nt Signature Date (Revised 9/23/2018)
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