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1 <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERE I i PERMIT SERVICES <br /> 5 <br /> . 3200 CEDAR STREET,EVERETT,WA 98201 <br /> `�� (P)425-257-8810 I FAX 425-257-8857 1(E)everettepsteverettwa.gov 1 www.everettwa.gavtpermits <br /> 6 <br /> PROJECTE SITE IiIN,ORM N <br /> PROJECT ADDRESS:2300 Merrill Creek Parkwa , Suite 100 <br /> PROJECT TYPE: OJNEW CONSTRUCTION ADDITION O ENANT IMPROVMENT IIIREMODEL <br /> BUILDING USE: [FR 0 TOWNHOUSE 0 s UPLEX 0 DU JO}iIIULTI-FAMILY-#OF UNITS: IR COMMERCIAL <br /> - <br /> BUILDING AREA: N/A sq ft <br /> ,, .... Fj ELECTRICAL APPLICATION`INFORMATION <br /> CONTRACT PRICE OF WORK:$1500.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO ❑YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? ® 0 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> _7 <br /> 1-MM. t , . .. 4D40:RIPTY0: O! MOR ::7:04r0--;:::0400-05- -,'',,NFA,' , <br /> DESCRiPTION OF WORK: Install time clock to control newly installed circuit for signs. <br /> r THIS SECTION P .S TO ALL EDUCAT ' , SITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> 121 y checkin, this box,I am - -ting that have read and un. tan. -II of WAG 296.460 sole d the specific reason on page 2 <br /> of this appli tion(se- ext page),A I Plan Revie is NOT requi ,• beca meet all of the fo wing sub ctions that do not <br /> e Page require Plan R- , . <br /> A ON OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> laPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or tease 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 /> CONTACT INFORMATION A 5 <br /> OWNER NAME: Safran USA, Inc. TENANT BUSINESS NAME(If Commercial): Safran <br /> OWNER MAILING ADDRESS: STREET 2300 Merrill Creek Parkway, Suite 100 <br /> cnv Everett STATE WA ZIP 98203 <br /> OWNER PHONE: (425) 407-6724 OWNER EMAIL: scott.huxsahl@safrangroup.com <br /> CONTRACTOR NAME: Seahurst Electric <br /> CONTRACTOR ADDRESS: STREET 2915 Chestnut St. <br /> Cny Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL:dleblanc aQseahurst.com <br /> CONTRACTOR UC.#(REQUIRED):SEAHUEIO99QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 <br /> PRIMARY CONTACT: LIMNER f ONTRACTOR []OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (425) 258-5143 <br /> Dave LeBlanc CONTACT EMAIL: dleblancaseahurst.com <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ail 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 lam 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> :ii`r'%' ...A:,. ...1..--,/‘,--\ 11)- 5-- ICS G 1 12''b`' <br /> -1?J <br /> Owner/Autho ad Agent Signature Date (Revised 10/30/2018) <br />