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425-259-2794 � �9:10 p.m. 1�-13-2016 2/2 <br /> E�ECTRICAL 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 /> 4920 Evergreen Way <br /> PROJECT ADDRESS <br /> Owner Mall Address City State/Zip Phone <br /> Staples <br /> Tenanl Mail Address Glty StatelZip Phone <br /> Seahurst EEectric 2915 Chestnut St Everett WA/98201 425-258-1882 <br /> Electrieal Contractor Mail Address Clty State/Zip Phone <br /> SEAHUE9 099QN 18763 <br /> Sta#e License Number(required) Cify of Everett Business License Num6er(required) <br /> 675.00 <br /> Proposed Use of Building Contract Price of Work <br /> Jon Novy 425-508-4320 <br /> jnovy@seahurst.com <br /> Square Footage(If rasidentia)new construction,remodei or addition} Contact Person/Contact Number/Email <br /> fVumber of devices(If low voltage) <br /> Descriptlon of Work to Be Dona: �nStall (9) LED W81I PaCk <br /> FEE <br /> CITY OF EVERETT LaCAL SALES TAX COpE IS 3105 � �� �� <br /> i <br /> I hereby certify that 1 have read and examined this application and know ihe same to be true and <br /> correct. A/l provisions oflaws and ordinances goveming this type of work wil!6e completed <br /> whether speci�ed herein ornof. The granting of a permif does not presume to give authority to PERMIT# <br /> violate or cancel tl�e provisions of any olher stafe or lacal law regulafing construction or fhe � I �I�` D�/� <br /> performance of construcfion. That i am authorized by the owner of fhis property to perform the � I <br /> work tor which application is made and I comp/y with fhe 5tate Contraciors Law 18.27 RCW and <br /> 296.200 WAC. <br /> '� l �/ <br /> Signatu e ' Dele <br /> REVlSED OHN6/1074 <br />