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425-259-2794 01 p.m. 12-26-2017 2/2 <br /> ELECTRICAL PERMtT APPLICATION <br /> CITY OF EVERETT PERM(T SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everet#eps@everettwa.gov � www.everettwa.govlpermits <br /> _. ...:. ..._ ,.�,.,:.. ����' &�.T�It����tl�AAT�ON <br /> �' N <br /> �.._. _ � . d.�,.,, ..�,m,�,...... ._.__..�._.,_ ._„�.... � ._� _ __.,.�_ ,,�.,.� ..._., _._,� .....�:. .._.:��, <br /> PROJECTADDRESS: 3025 LOMBARD ST <br /> BUILDING AREA(if resldenllal,new constructlon,remodel,or addltion) SF <br /> BUILDING TYPE: ❑5FR-DETACHED ❑SFR-ATTACHED ❑ pUPLEX ❑ MULTI-FAMILY-#�OF UNITS: �COMMERCIAL <br /> usEOF sui�olNG: GIPSON SENIOR CENTER <br /> :�. ._ .�:� ...,,..�. ..�„�. , �EG _ .N.�AL APPL�CAT�b.�_I�NI�,�RMAT1pN..:.;._ .._ ..:. _ ._:.:: „ ;; <br /> , _ ... . <br /> GONTRACT PRICE OF WORK:�$ 1500.00 .' <br /> NUMBER�F DEVICES if low v,'plta e : NA <br /> FIRE ALARM? C]YES ��;�, ��1p <br /> ASSOCIATED BUI�DING PERMI a' licable : NA <br /> �ESCRIPTION OF wORK: INSTALL (1) NON METALIC FLOOR BOX TO REPAIR DAMAGED CONDUITS <br /> POWERING TWO WALL HEATERS <br /> ....:. � .._..:'�,.. .....; �!��'�'4►CT,����?�,MATI�N ` <br /> � .. . ...... . ... ....._ .. ... ...� ...:. . ,....:. . ,...... .. .. . <br /> OWNER NAME: CITY OF EVERETT �HANT NAlu�e(Ef Commerctal): GiPSON SENIOR CENTER <br /> OWNER MAILING ADDRESS: slxeeT 2930 WETMORE AVE <br /> �,T,. EVERETT SiATE W�1 Z,P 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRAC70R NAME: Seahurst Electric <br /> C�NTRACTOR ADDRESS: s�EEr 2915 Chestnut St <br /> �R,, Everett g�q� WA z�;98201 _ <br /> CONTRACTOR PHONE: '425-258-�882 coNTrtacroR Ennat�: reception@seahurst.00117 <br /> CONTRACTOR LIC.#�REcauiRE�a: SEAHUE1099QN C[TY OF EVERETT BUSINESS LIC.#(REQUIRED; 18763 <br /> _ . _ I <br /> __ ._ _ __ _ _ <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER(Ptease Specify} � <br /> CaNTACT NAME: Kim Smith CaNTACT PHONE: 425-258-�8a2 �y� <br /> PM JEFF HERRMANN -425-309-2554 conrrac-r EMat�_ reception@seahurst.com <br /> AGREEMENT:!hereby certlfy that/have iead and eramined this npplication and know fhe seme to be irue end cortr3ef. Af!provlsians af tews and ordinencos flaveming this type <br /> of work wi11 he campleted whether specified heisin ornot. The granfinr�of a pemrit does not presume to givo au[honty to violate or cance!tha pravisrons af any other stale ar <br /> loca!law regu/aling construction or/he perfomrance ol constructian. Tire!I am autharized by tha owner o(this property to perfarm Ihe work for which epplication rs mado and I <br /> comply with the State Contracfors Law iH.27 RCIN and 296.200 WAC. <br /> Cify of Everett��cia/Use Onty <br /> ' PERMIT# <br /> � �� � � -/� E �� �2. - ��''� <br /> Ow er/ horized A ent Signature Date (Rovised 9/23/2016) <br />