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08/28/2019 03 : 51 #4379 P. 001/001
<br /> NMI
<br /> 1; ELECTRICAL PERMIT APPLICATION
<br /> CITY
<br /> EVERETT 3200 CEDAR STREETP
<br /> , I EVERETT,WA 8 201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps©everettwa.gov I www.everettwa.gov/permits 1 �
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<br /> PROJECT ADDRESS: 334 V TMORE AVE BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW C NSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT 1] REMODEL
<br /> BUILDING USE: Q SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 750 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: _
<br /> REPLACE DAMAGED HOT WATER TANK CIRCUIT
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<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO Q YES-Select Scope: ❑Service ❑ Feeder Q Circuits-#:1 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE=(REQutRED): El Data Q Intercom ❑Thermostat El 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 /> El Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: IJ 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO DYES-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: COLEEN LEWIS TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srRar 3834 WETMORE AVE
<br /> carr EVERETT STA-r WA „98201
<br /> OWNER PHONE:2O6.240.9717 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES & SERVICE
<br /> CONTRACTOR ADDRESS: sTREE-r3601 EVERETT AVE
<br /> ckrr EVERETTaP 98201
<br /> STATE WA
<br /> CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL.' Y ander
<br /> ce I @yahoo_com
<br /> CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED)-016363
<br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) r1
<br /> CONTACT NAME: CONTACT PHONE:425.231.2275
<br /> corny 1st CONTACT EMAIL:jceylander@yahoo.com
<br /> AGREEMENT I hereby certify that I have read and examined this application and know the same to be true and correct All provisions cif laws and ordinances governing this
<br /> type of work will he 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 206.200 WAC. City of Everett Official Lea Only
<br /> PERMIT#:
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<br /> 062/02-6V/ E V� oV -- 1ST
<br /> Owner/A `orized Agent Signature / (Revised 1/11/2019) Pane 1-Application
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