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425-259-2794 0:01 p.m. 06-05-2017 2/2
<br /> ELECTRtCAL PERMiT APPLICATION
<br /> CITY OF EVERETT AERMIT SERVlCES
<br /> 3200 C�DAR STREET, EVERETT,WA 98201
<br /> (P)425-257-6810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.evere€twa.gov/permits
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<br /> PR�JECTADDRESS: 1205 CRAFTSMAN WAY BOATHOUSE H-17
<br /> BUILDING AREA(If residential,new canstructfon,remodei,or addition) 5F
<br /> BUILDING TYPE: �5FR-DETACHEd ❑ 5FR-ATTACHED ❑dUPLEX �MULT[-FAMILY-#OF UNITS: I�COMMERCIAL
<br /> U3E OF BU[LDING: BOATHOUSE
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<br /> CONTRACT PRICE OP WORK:$ 500.00
<br /> NUMBER OF DEVICEB if low volta e :
<br /> FIRE ALARM? ❑YES �NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable:
<br /> DESCRIPTION OF WORK:
<br /> iNSTALL NEW POWERCORD AND 30AMP CORD CAP AT BOATHOUSE H-77 ELECTRICAL METER, CENTRAL
<br /> DOCK H, PORT OF EVERETT
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<br /> OWNER NAfUIE: STAN SIMONSON TEHANT NAME If Commercial):
<br /> OWNER MAILING ADDRESS: smeeT
<br /> �,,,, MARYSVILLE STA�WA Z,P
<br /> DWNER PHONE: 36Q-926-3049 � QWNER 6MAtL: bobseasno@yahoo.00111
<br /> CONTRACTOR NAME: S@ahUPSt EIeCEI'IC
<br /> CONTRACTOR AD�RESS: s��er 2915 Chestnut St
<br /> �„i, Everett sTA� WA Z� 98201
<br /> CONTRACTOR PHONE: �25"258��$82 CONTRACTOR EMAIL: f@C@j�tIOR C@5@aIIU�St.CORI
<br /> CONTRACTOR UC.#{REQUIREDJ: SEAHUE1099QN CITY OF EVERETT BUSIMESS LIC.#(REQUIRED): 18763
<br /> PRIMARY CONTACT: �OWNER �CONTRACTOR 0 OTHER{Ple�se Specify)
<br /> CONTACT NAME: Kltri SlYlith CONTACT PHONE: 425-258-'IH$2
<br /> PM -Jeff Herrmann coNTacr�Ma��: reception@seahurst.com
<br /> AGREEMENT:!hereby ceRify that i have read and ezamined this application and knaw the ssme to ba true and Correcf. Ap prov/slons of lews and ordinances govemlttg thPs ryps
<br /> af work wt0 be compfeted wheiherspacified harern ornof. 7he granfing nf a permif doas not prasume lo give aufhoRfy to vialate or cancel the provisinns of any afher staie or
<br /> /ocsl law regulating�onstruciron ar ihe pertormance o1 construcfion. That I am authorized by the owner of this praparty fo peiform the wvrk tor which applicatlon!s made and!
<br /> cnmply with the 5fate Contracfors Law 18.27 RC W a�d 286.2DD LVAC.
<br /> Cily of Evefett O�cta/Use�nty
<br /> . 1� PERMIT#
<br /> f E b(�-b� (o
<br /> �� � �� ����
<br /> ner/Authoriz AgentSignatura date (Revised9/23/2096}
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