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04/22/2019 20 : 33 „4160 P. 002/003
<br /> 1111111111
<br /> ELECTRICAL PERMIT APPLI ATION
<br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES
<br /> 00 CEDAR STREET,EVERETT,WA 98201
<br /> wwsrrrnaroN (P)425-257-8810 I FAX 425-257-8857 I(F)everettepsdeverettwa.gov l www.everettwa,gov/permits
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<br /> PROJECT ADDRESS: 6420 BEVERLY BLVD#B BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION LI ADDITION ❑TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: Q SFR El TOWNHOUSE Q DUPLEX Li ALU LI MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE GAS FURNACE
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE; (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO CI YES-Select Scope: ❑Service ❑ Feeder CI Circuits-#:1 [I Complete Re-wire
<br /> LOW VOLTAGE WORK? �NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom ❑Thermostat ❑Audio Q Secure Access
<br /> Security System
<br /> Li 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: U NO r YES—See Below& Pg.2
<br /> By checking this box, I am stating that I have read and understand all of WAC 296-466-900,setectsd 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: el NO EYES-See Below&Pg.3
<br /> n 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
<br /> y-w... \.,. ,r f ,_-- - "W- •. .. requirement.ent.
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<br /> OWNER NAME: BRIAN GREGORY TENANT BUSINESS NAM_JIf Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE:206.604.9711 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SSALES & SERVICE
<br /> CONTRACTOR ADDRESS: STREET3601 EVERETT AVE
<br /> CITY EVERETT STATrw WA ZIP 98201
<br /> CONTRACTOR PHONE:425-259-2161 !CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED):EYI-ANSS142K2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363
<br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ['OTHER(Please Specify)_
<br /> CONTACT NAME: CONTACT PHONE:425.231.2275
<br /> CORNY EY CONTACT EMAIL:jceylander@yahoo.corn
<br /> A REEMENT:I hereby certify that I have road and examined this application and know the same to be true and correct All pmvislons of laws and ordinances governing this
<br /> type of work will be completed whether specified Itereln 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 =.ulating construction or the performance of construction. That l ant authorized by the owner of this property to perform the work for which application is made and I
<br /> comply w the S Contractors Law 18-27 RCW and 296.200 WAC. City of Everett Orf ielat Use Only
<br /> PERMIT#: -
<br /> ,��� a E (7 nu --
<br /> F ner/Autho 'fel Agent Signature Date (Revised 1/11/2019)
<br /> Page 1-Application
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