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EL.CTRICAL PERMIT APPLIC,; ;'ION
<br /> 4L7- CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I wvw.everettwa.gov/permits
<br /> _' : EJECT SITE:INFORM ., Ca• W ,
<br /> PROJECT ADDRESS: 7301 Hardeson Road BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTN ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑ SFR . 3 . NHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS:_ 0 COMMERCIAL
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<br /> EL ' ',,1,,.:.r:':::,,.'„ ,A,MIONINfORMATION & DEIKRI OS .'• "
<br /> CONTRACT PRICE OF WORK:$ 19,800.00 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 16546 1901213 - Add (6)-receptacles, (3) loading dock fixtures, (12) LED light fixtures
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 111NO fl YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:4 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE (REQUIRED) ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ 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):
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<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: N,NO V, 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 /> v 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: ONO 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 exemptiontifrom this licensing/certification requirement.
<br /> ,... r 3, ,..:E ,..,..\i�n',..ir"�`\'» NTA. ;RMATIo '' ,i7-777 \` .z \\. k1_ ;
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): — Ue-T
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Titan Electric
<br /> CONTRACTOR ADDRESS: STREET 12828 Northup Way Suite 205 1/�,
<br /> c, Bellevue STATE V YA ZIP 98005
<br /> CONTRACTOR PHONE:206.633.2811 CONTRACTOR EMAIL:Permits@titanelectric.net
<br /> CONTRACTOR LIC.#(REQUIRED):TITANE1963oe ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51191
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<br /> PRIMARY CONTACT: El OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206.633.2811
<br /> Jon Osborn CONTACT EMAIL:permits@titanelectric.net
<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 R W and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> 7fr` j 6/5/2019 E` ��O C - O 3
<br /> (4
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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