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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> _ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettepstc�everettwa.gov I www.everettwa.gov/permits <br /> y :4.017OJECTzSITE INFO ` TOA, TSe <br /> e <br /> PROJECT ADDRESS:6525 Hardeson Rd. <br /> PROJECT TYPE:['NEW CONSTRUCTION ❑ADDITION Ila NANT IMPROVMENT ['REMODEL <br /> BUILDING USE: I a PFR 0 TOWNHOUSE 0 UPLEX ❑ DU ❑Iv1ULTI-FAMILY-#OF UNITS: ga COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELERIO)WOPLiCATIQ rt(0 TION177a ;; 1. <br /> CONTRACT PRICE OF WORK:S 30,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 10 NO �❑YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? illi®___NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> '':.:: ;!:4S!k4Z.i':":',)Yirn: 715Wk)Eg:C:*ItkI:(0:,-,t410:CbfO)tk,;„„„AIPP:0E7,0::0(*PltittKC::A4Z-ZZlk!MZEIIZL <br /> DESCRIPTION OF WORK: Add 2-200A,480v panels. Add 12-30A twist lock equipment drops from newly installed panels. <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> liaBy checking this box,I am stating that I have read and understand all of WAC 296.460-900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> ® Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without <br /> the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> 4°`` 's _ _. .MATIO , , a te. ; <br /> ` � CONTACT INFOR <br /> OWNER NAME: Enerci Fenstration TENANT BUSINESS NAME(If Commercial): Same <br /> OWNER MAILING ADDRESS: STREET 6525 Hardeson Rd. <br /> cmr Everett STATE WA ZIP 98203 <br /> OWNER PHONE: (425)407-0700 OWNER EMAIL: N/A <br /> CONTRACTOR NAME:Seahurst Electric <br /> CONTRACTOR ADDRESS: STREET 2915 Chestnut St. <br /> �� Everett STATE WA ZAP 98201 <br /> CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL: reception(seahurst.Com <br /> CONTRACTOR LIC.#(REOUIRED):SEAHUEI099QN [CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 <br /> PRIMARY CONTACT: DOWNER CONTRACTOR MOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (425) 258-5143 <br /> ` Dave LeBlanc CONTACT EMAIL: dleblanc(seahurst.com <br /> AGREEMENT:I hereby certify that f have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances <br /> 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 <br /> provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> City of Everett Official Use Only <br /> 4)4, P MIT# <br /> \t= 112,, Dq <br /> Owner/Author; d Agent Signature Date (Revised 10/30/2018) c Page'I of 3 <br />