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09/30/2013 13 : 07 #4431 P. 001/001
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<br /> m eLECTRICAL PERMIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WAaHI NGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsgeverettwa gov I wwweverettwa.gov/perrrilts
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<br /> PROJECT ADDRESS: 2105 BROADWAY BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ✓I TENANT IMPROVMENT ✓0 REMODEL
<br /> BUILDING USE: 0 SFR E]TOWNHOUsE El DUPLEX ❑ADU LI MULTI-FAMILY-#OF UNITS:4 _ Q COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 2000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 3- 50AMP RECEPTACLES FOR 2 HEATERS AND 1 SET OF SPIDER BOXES
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? E_] NO a YES-Select Scope: ❑Service3
<br /> ❑ Feeder El Circuits-0:3 []Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO Ea YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El 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 end installation approval.
<br /> ❑Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO n YES—See Below&Pg.2
<br /> By checking this box, I am stating that I have read and understand all of WAC 29646B-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: CFNO EYES-See Below& Pg.3
<br /> ( 1 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> l I 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: BEHARS FURNITURE TENANT BUSINESS NAME(If Commercial :
<br /> OWNER MAILING ADDRESS: STREET 2105 BROADWAY
<br /> CITY EVERETT STAre WA aP 98201
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES & SERVICE
<br /> CONTRACTOR ADDRESS: STRr±ET3601 EVERETT AVE
<br /> cin EVERETT STATE WA ZF 98201
<br /> CONTRACTOR PHONE:425.259.2161 {CONTRACTOR EMAIL:Jceyiander@yahoo.com
<br /> CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#REQurRED);016363
<br /> PRIMARY CONTACT: DOWNER ['CONTRACTOR ✓❑OTHER(Please Specify) _
<br /> CONTACT NAME: CONTACT PHONE:425.231.2275
<br /> corny TOO CONTACT EMAIL:jCeylander@yahoo.cOm
<br /> AdREEMENT.:I hereby certify that l 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 properly to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 ROW and 286,200 WAC, City of Everett Official Use Only
<br /> PERMIT#:
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<br /> 0 uthorized Ag t S g pate (Revised 1/11/1019) Page 1-Application
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