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ECTRICAL PERMIT APPLI TION
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES w 1 Aitt
<br /> 3200 'e1
<br /> CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> WASHINGTON
<br /> . NA , z . " RFtftRAECT`VgiINFORMArON. Y 4 t3
<br /> 2kx i
<br /> PROJECT ADDRESS: .1 ( O el& .e $Zai BUILDING AREA: V\22 sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL
<br /> .. ?i,a`. .„s r>_. MAWI JoN '! MAT $,+ ;. S►CR!,P'T NM OF WO . x,'r _ ; a. ,.,_.
<br /> CONTRACT PRICE OF WORK:$ 8,000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Add devices to an exsisting access control system.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 12 NO ❑YES-Select Scope:❑Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO El YES-#of Devices:15
<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):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ri NO LJ YES--See Below&Pg.2
<br /> ay I 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 /> u 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.
<br /> x 3 xg `N um`isoma _z `�� '�-s N myk i ^.v ,.ri >�';xNNrte, SI >
<br /> MO
<br /> OWNER NAME: everett public schools TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3900 broadway
<br /> CITY everett STATE wa ZIP 98201
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Steele electric
<br /> CONTRACTOR ADDRESS: sTREET4722 bayview lane
<br /> CITY Everett STATE WA ZIP 98203
<br /> CONTRACTOR PHONE:425-876-7488 CONTRACTOR EMAIL:traviS@SteeleeC.cOm
<br /> CONTRACTOR LIC.#(REQUIRED)STEELEI841 CS CITY OF EVERETT BUSINESS LIC.#(REQUIRED)
<br /> PRIMARY CONTACT: DOWNER DCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-876-7488
<br /> travis steele CONTACT EMAIL:travis@steeleec.corn
<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
<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
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> -161 , � ) 1 E 11101 1 i
<br /> Owner uthorized gent Si (Revised 1/11/2019)
<br /> ture Dat
<br /> Page 1-Application
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