623 107TH PL SE 2019-08-14 - Laserfiche WebLink

1111Pzi.7—,4 ELECTRICAL PERMIT APPLICATION AV" CITY OF EVERETT PERMIT SERVICES 4110Wi.7 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITEINFORMATION , • PROJECT ADDRESS: 623 107th Place SE BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS' 0 COMMERCIAL USE OF BUILDING: Single Family Residence ,rc ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 810 NUMBER OF DEVICES(if low voltage): 1 FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK; INSTALLATION OF A CIRCUIT TO ACCOMMODATE AN EV CHARGER CONTACT INFORMATION OWNER NAME: LUONG VO(SE#542105) TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 623 107TH PLACE SE ciry EVERETT STATE WA zip 98208 OWNER PHONE: 425.232.5003 OWNER EMAIL: MAILUONG02@YAHOO.COM CONTRACTOR NAME: SEAHURST ELECTRIC CONTRACTOR ADDRESS: STREET 2915 CHESTNUT STREET cm/ EVERETT STATE WA zgp 98201 CONTRACTOR PHONE: 425.258.1882 CONTRACTOR EMAIL: SWILLMORTH@SEAHURST.COM CONTRACTOR LIC.#(REQUIRED): SEAHUE1O99QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425.238.7724 ROB LAYES CONTACT EMAIL:RLAYES@SEAHURST.COM AGREEMENT-I hereby certify that I have mad and examined this application and know the same to be true and correct. All provisions of laws and ordinances 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 provisions of any other state or local law regulating construction or the performance of construction That!am authorized by the owner of this property to perfomi the work for which application Is made and! comply with the State Contractors Law 18.27 ROW and 296,200 WAC City of Everett Official Use Only PERMIT# 7/2,3P E \%0q- Owner/Authorized Agent Signature Date (Revised 9/23/2016)