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ELECTRICAL PERMIT APPLICATION
<br /> 0477. CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov( www.everettwa.gov/permits
<br /> w PROJECTiSITE:INFORMATION_ . ... . ;':
<br /> PROJECT ADDRESS: 3900 Broadway Everett, WA 98201 BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> NE ; ,;,.,, Of ,,,.:; ELEC.T.RICAL APPLICATION,INFORMATION,,&:;DESCRIPTION:'OF,.W..QRK ,., -
<br /> CONTRACT PRICE OF WORK:$ 2,000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> (3) Dedicated Receptacle Circuits
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:El Service ❑ Feeder ❑Circuits-#:3 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data El Intercom ❑Thermostat El Audio ❑Secure Access El 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):Circuits
<br /> l . s< fi,x �>._ " r ; ,. ;' CODE;COMPLIANCES j, ` . -:
<br /> „,,.w.. ,.:,..,....-:, Jar r ._.:.:,... �..�.���=.a ..�.,.,...,,
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO Id YES—'See Below&Pg.2
<br /> By checking this box, I am stating that I have read and understand all of WAC 296.468-900,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 DYES-See Below&Pg.3
<br /> ❑
<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 /> . ' ont NSRCONTACT INFORMATION , ,.,I ... EI ,. ,EWISSZA7 :.._
<br /> OWNER NAME: Everett Public Schools TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3900 Broadway
<br /> ,,Ty Everett STATE WA zP 98201
<br /> OWNER PHONE:425-3855-4170 OWNER EMAIL:
<br /> CONTRACTOR NAME: Precision Electric Group Inc
<br /> CONTRACTOR ADDRESS: STREET15323 NE 90th Street
<br /> cry Redmond SPATE WA zp 98052
<br /> CONTRACTOR PHONE:206-948-9802 CONTRACTOR EMAiL:terryd@pegi.biz
<br /> CONTRACTOR LIC.#(REOUIRED):PRECIEG969PH CITY OF EVERETT BUSINESS LiC.#(REQUIRED):047780
<br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-948-9802
<br /> Terry DuBeau CONTACT EMAIL:terryd@pegi.biz
<br /> AGREEMENT:I hereby certify that t 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 l am authorized by the owner of this property to perform the work for which application Is made and t
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> 03/22/2019 E (6103 - 153
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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