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ELECTRICAL PERMIT APPLICATION
<br /> �'/— CITY OF EVERETT PERMIT SERVICES
<br /> Imo' , 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: 408 Rockefeller Ave., Everette, WA 98201 BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: ❑✓ SFR El TOWNHOUSE El DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:S' \S O C ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> DESCRIBE SCOPE OF WORK:
<br /> Replace damaged meter and service wire
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO ✓❑YES-Select Scope: ✓❑ Service El Feeder ❑ Circuits-#: ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? ✓❑ NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data El Intercom E Thermostat ❑Audio El Secure Access ❑ Security System
<br /> El 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):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO III YES—See Below&Pg.2
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<br /> 7 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: ONO 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.
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<br /> OWNER NAME: Mary Leach TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 408 Rockefeller Ave
<br /> c,T,, Everett STATE WA 21,98201
<br /> OWNER PHONE: 425 220-8966 OWNER EMAIL:
<br /> CONTRACTOR NAME: J and J Electric
<br /> CONTRACTOR ADDRESS: sTREET1830 112th St E, Suite M
<br /> c,TE Tacoma STATE WA zip 98445
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<br /> CONTRACTOR PHONE:253-212-3785 CONTRACTOR EMAIL:)osh@d jandjelectric.Us
<br /> CONTRACTOR LIC.#(REQUIRED): EC JJELEJE869CL CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 055604
<br /> PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 253-301-9392
<br /> Josh Matthew:CONTACT EMAIL: josh(jandjelectric.us
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this r
<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 em 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#:
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<br /> 1.90 ( ----s wner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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