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1 <br /> I••• <br /> `i ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I w+,wr.everettwa.gov/permits <br /> z <br /> ECT SITE INFORMATION -T:f ! 3'5 , <br /> PROJECT ADDRESS: 1317 Hewitt Ave Everett, WA 98201 BUILDING AREA: 1200 sq ft <br /> PROJECT TYPE; ❑ NEW CONSTRUCTION El ADDITION L I✓ TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE CI DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS:_ ©COMMERCIAL <br /> °.., ELECTRICAL APPLICATIONJINIFORMATION & DESCRIPTION-'OF W" ;' , .r <br /> CONTRACT PRICE OF WORK: $ 1650.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Installing new security and CCN system <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 171 NO ❑YES-Select Scope:El Service ❑Feeder ❑Circuits-4: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO 171 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED), El Data El Intercom ❑Thermostat ❑Audio El Secure Access Q Security System <br /> El Fire Alarm-Installations under this permit only Include electrical wiring rough-in of the system.An additional <br /> FireirtAlarm Permit is required for review of device location and installation approval. <br /> El Other(List All): <br /> 41C,1� DE"COMPLUANCE• , <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH E. <br /> ALTH ANO(OR PERSONAL CARE FACILITIES: ✓C] NO El 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: 71NO 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'INFORM1llThDI+L444� *5 '" <br /> OWNER NAME: Athena Walker TENANT BUSINESS NAME(If Commercial): WaXology <br /> OWNER MAILING ADDRESS: STREET 1317 Hewitt Ave <br /> ,,n Everett NATE WA z,P 98201 <br /> OWNER PHONE:360.888.8889 OWNER EMAIL: <br /> CONTRACTOR NAME: Guardian Security <br /> CONTRACTOR ADDRESS: STREET 17431 First Ave S <br /> CITY Seattle rr � STATE WA ZIP 98134 <br /> CONTRACTOR PHONE:360.647.0110 CONTRACTOR MAIL:hFi t t;guardiansecurity.com <br /> CONTRACTOR LIC.#(REQUIRED):GUARDSS233K5 CITY OF t E"- I BUSINESS LIC.#(REQUIRED):0033443 <br /> PRIMARY CONTACT: [DOWNER EilCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360.647.0110.x328 <br /> Heidi MetoU r CONTACT EMAIL:hmetour@guardiansecurity.com <br /> AGREEMENT.I hereby certify that/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 /> focal 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 t <br /> comply with(1I State Contractors Law 18,27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> / <br /> :1-4 /->/11 ''''4-1-1 //12 C t - '' a 20/9' E _} 100 <br /> Ov)(nerPlAuthoriYed Age2t Sigrtat ® D to (Revised 1/11/2019) Page 1-Application <br /> �E= <br /> I <br />