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CLECTRICAL PERMIT APPLICATION <br /> 4677- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (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: 1 601 112th St SW APT#6 BUILDING AREA: 600 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL <br /> BUILDING USE: ❑SFR ✓❑ TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 1500 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Kitchen Remodel - Completed by different contractor without permit. SeaTown purchasing permit and <br /> taking responsibility for inspection corrections. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: El Service El Feeder ❑✓ Circuits-#:3 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED). El Data ❑ Intercom ❑ Thermostat ❑Audio El Secure Access El Security System <br /> ❑ 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 /> OMPUANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: IJ NO El YES--See Below& Pg.2 <br /> By checking this box, I am stating that I have read and understand all of WAC 296-46B-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 /> T 1NFOR <br /> OWNER NAME: MaUra Castillo TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1601 112th St SW#6 <br /> c,,,r Everett STATE WA ZIP 98204 <br /> OWNER PHONE:2069020272 OWNER EMAIL:maurac21@hotmail.com <br /> CONTRACTOR NAME: SeaTown Electric Corp. <br /> CONTRACTOR ADDRESS: STREET 3431 Broadway <br /> CITY Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:206-905-4946 CONTRACTOR EMAIL:permits@seatownservices.com <br /> CONTRACTOR LIC.#(REQUIRED):SEATOEC86ORB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53916 <br /> PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-905-4946 <br /> Bekah Swanson CONTACT EMAIL:permits@seatownservices.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 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 /> 9/20/19 E vF ❑ OV <br /> Owner/Aut ori d Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />