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3330 WETMORE AVE 2019-11-07
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3330 WETMORE AVE 2019-11-07
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Last modified
11/7/2019 11:29:29 AM
Creation date
11/7/2019 11:29:18 AM
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Address Document
Street Name
WETMORE AVE
Street Number
3330
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MEI <br /> iLlLEGIRFICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:_ (l'l4 F c �� BUILDING AREA: sq.t <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT :0 REMODEL <br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION 134.;DESCRIPTION,.OF WORK <br /> CONTRACT PRICE OF WORK: $ 13-0041-L- ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: (n1►f7N16 �� 1Me L/1F.-cidzr <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO Ei YES-Select Scope: ❑ Service ,[] Feeder ❑ Circuits-#: - ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat El Audio ❑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): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ 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 /> CONTACT INFORMATION <br /> OWNER NAME: 1..,\Nc1 SXc'w ) . TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3330 l),34?'t pro <br /> CITY 91+ STATE W <br /> OWNER PHONE: ." ) r' � ;C1C OWNER EMAIL: <br /> CONTRACTOR NAME: 4 \SS1(�} �t�c�r�C cc I Cf.> <br /> CONTRACTOR ADDRESS: STREET p•0 . , Ct(.4 <br /> CITY T '1C) <br /> �'+ � r <br /> �1 ' STATE , ZIP ,_I�Ic <br /> CONTRACTOR PHONE:`��-3�'9 39 IICONTRACTOR EMAIL:d(,it\, ;�',j-;.v ('„?91 CO C cd 11 1 <br /> CONTRACTOR LIC.#(REQUIRED):Cr'C�Sr�-(. ,C311 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0.5 D I GIS <br /> PRIMARY CONTACT: EOWNER .CONTRACTOR ❑OTHER(Please Specify) <br /> /+ <br /> CONTACT�� NAME: _ / CONTACT PHONE: ?CD y _ Q�g ' /� J <br /> ,110, ` Tris a'v CONTACT EMAIL: tr�C) SS�t" 0_-) l VSD .ccr,9/ , Ili 1 <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 i <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> g E 1g & -/ i 1 <br /> Owner/Au oriz d Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />
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