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03/22/2019 08: 45 #4098 P. 001/001
<br /> ELECTRICAL PERMIT APPLICA i ION
<br /> CITY OF EVERFTT PERMIT SERVICES
<br /> _ 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 FAX
<br /> FAX 425.257-8857 I(E)everettepsQeverettwa.gov I www.everettwa.govlpermis
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<br /> PROJECT ADDRESS: 3212 16th STREET BUILDING AREA: sq ft
<br /> PROJECT TYPE; El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT LI REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 7355 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE 4 METER PACK SERVICE
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? Q NO (I YES-Select Scope: Q Service Q Feeder ❑Circuits-#: _ ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data Q Intercom ❑ Thermostat Li Audio El Secure Access El Security System
<br /> Ti] 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 PE IT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: o NO ■ YES–See Below& Pg.2
<br /> By checking this box,I am stating that I have read and understand all of WAC 29b-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 ✓C�NO YES-See Below&Pg.3
<br /> fl 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:WINDERMERE TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 7100 EVERGREEN WAY SRUITE A
<br /> �j
<br /> CIN WA
<br /> EVERETT STATE ZIP 98203
<br /> OWNER PHONE:206.387.3827 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANCER SALES & SERVICE
<br /> CONTRACTOR ADDRESS: EVERETT AVE
<br /> ciTy EVERETT STATE WA :,P 98201
<br /> CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363
<br /> •
<br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑✓OTHER(Please Specify) —�
<br /> CONTACT NAME: CONTACT PHONE:
<br /> J C E N OTM E CONTACT EMAIL:
<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 /> /Atho9nar
<br /> ?Contractors Contractors Law 18.27 RCW and 288.200 WAG. Cl of Everitt Official Use On
<br /> PERMIT#:
<br /> e Date (Revised 1/11/2019) Page 1-Application
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