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ELECTRICAL PERMIT APPLILATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.evere gov/permits <br /> 4rErr <br /> PRO ECThItE iNFORMATIo . <br /> PROJECT ADDRESS: 1605 Rainier Avenue BUILDING REA: 768 / sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 0 7 EMODEEL <br /> BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADUElMULTI-FAMILY-'• OF UNIT:': ❑ COMMERCIAL <br /> A <br /> CONTRACT PRICE OF WORK: $ 12500 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Complete rewire with panel and service upgrade <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ✓❑YES-Select Scope: ✓❑ Service ❑ Feeder ❑ Circuits-#: ❑✓ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑Secure Access ❑ Security System <br /> ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> CODE-COMP LIANCL,_-_ ' <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 171 NO ❑YES--See Below&Pg.2 <br /> By 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: ENO EYES-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 <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> ...r .:,.. ,, :. ....,... . ONT ,'CT INFOR [ATI r. .•'. . . ;K. ....,»v. <br /> OWNER NAME: Joseph Irizarry TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1605 Rainier Avenue <br /> ciTr Everett STATE WA Zip 982001 <br /> OWNER PHONE:4255011296 OWNER EMAIL:Irizarry.joseph@gmail.com <br /> CONTRACTOR NAME: Seatown Electric Corp. <br /> CONTRACTOR ADDRESS: sTREET3431 Broadway <br /> CITv Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:2069054946 CONTRACTOR EMAIL:permits@seatownservices.com <br /> CONTRACTOR LIC.#(REQUIRED):SEATOEC86ORB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53916 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-905-4946 <br /> Bekah Swanson CONTACT EMAIL:permits@seatownservices.com <br /> AGREEMENT I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> Fg 7/26/19 E 10 .�-- kg14 <br /> Owner/AuthorizedSignature Date (Revised 1/11/2019) Page 1-Application <br />