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ELECTRICAL I RMIT ; � ��, �,...� or- �- <br /> CI ` �EVERETT PERMI SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> • <br /> PROJECT ADDRESS:905 Westmore Avenue, Everett, 98201 -Everett community College Nippon Business Institute <br /> PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: O COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ,e <br /> CONTRACT PRICE OF WORK:$1,000 ASSOCIATED BUILDING PERMIT#(if applicable): nit(Ced56(5(, <br /> IS THIS LOW VOLTAGE WORK? El NO O YES-#OF DEVICES:2 <br /> IS THIS A FIRE ALARM PERMIT? ✓❑ NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK: Install (2)Low Volt Thermostats <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO El YES--See Below&Pg.2 <br /> OBy checking this box, I am stating that I have read and understand all of WAC 296-46B-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 /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO OYES-See Below&Pg. 3 <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 /> OWNER NAME: State of Washington-Department of Enterprise Services TENANT BUSINESS NAME(If Commercial): EvCC Nippon Business Institute <br /> OWNER MAILING ADDRESS: STREET 1500 Jefferson Street <br /> cr,, Olympia STATE WA ZIP 98504 <br /> OWNER PHONE.360-701-9545 Susan Smith,PE(OWNER EMAIL.susan.smith@des.wa.gov <br /> CONTRACTOR NAME:D.K. Systems, Inc. <br /> CONTRACTOR ADDRESS: STREET PO Box 886/962 S. Spruce Street <br /> cir'Burlington STATE WA zip 98233 <br /> CONTRACTOR PHONE:360-755-1555 dtelCONTRACTOR EMAIL:shayes@dksystemsinc.com <br /> W+ <br /> CONTRACTOR LIC.#(REQUIRED):DKSYSI*982L1 D6�TstCITY OF EVERETT BUSINESS LIC.#(REQUIRED): _ 0 44 <br /> PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-391-5338 <br /> Steve H ayes CONTACT EMAIL:shayes@dksystemsinc.com <br /> AGREEMENT:t hereby certify that/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/comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT#`/'�► <br /> Dulce HerreraDigitally s1gned by Duce Herrera 03-06-2019 ` ®� �� <br /> r Date:2019.03 06 09:19:04.08'00' <br /> Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application <br />