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ECTRICAL PERMIT APPL■mTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> RO . .'aSIT 1N <br /> PROJECT ADDRESS:-I-7 2., i)E Soli (�1�.(�U �r(IA 16201 BUILDING AREA: 12-9 1 I sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: '.1 COMMERCIAL <br /> .. ,_...r _ LEOX . L API ICATION IN gmok ON-&* RIP "ION1 :. <br /> !i r <br /> CONTRACT PRICE OF WORK:$ 165-0.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: /tDi I ( 2) /,0-RA1 c-rgo864- '?' ' I3A ' (3) IN r6.0.44 62-s ?de. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? Kt NO ❑YES-Select Scope: ❑Service El Feeder ❑Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? El NO D4 YES-#of Devices: 7- <br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio El Secure Access ❑Security System <br /> IA 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): <br /> dt .:_/ .;v J, lR;. ;t r E I y"Si T �'. "� Y s„ '" r, �-4:S }X Q 8. . ReaNg <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ®NO ii YES--See Below&Pg.2 <br /> fl 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: ®NO EYES-See Below&Pg.3 <br /> I i 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 /> OWNER NAME:k tZIC.L.p1.60 ( A Y 1N-VeS T119Eaf*ZS TENANT BUSINESS NAME(If Commercial): rem& imez.. <br /> OWNER MAILING ADDRESS: STREET 2414 3 0 7-it. 1fire• S-re. <br /> CITY 13 (-eV'lLE STATE WA-- ZIP 6 <br /> OWNER PHONE: LI X Z8't 1St,5OWNER EMAIL: Kkr/As e,..-r05enha-b©Wie eats <br /> CONTRACTOR NAME:Mit ( ()Rh-"e-Ti eiu <br /> CONTRACTOR ADDRESS: STREET 3013 3 j)j IUOiz114 <br /> CITY Se> -r--rLE STATE If1)& ZIP 79I <br /> CONTRACTOR PHONE:20(0 "2 {—177►1 CONTRACTOR EMAIL: 17 ra'j ti -(t,qot_4; <br /> CONTRACTOR LIC #(REQUIRED) !ek iEr g4 i(3 CITY OF EVERETT BUSINESS LIC #(REQUIRED): O 2.1(9.4. <br /> PRIMARY CONTACT: DOWNER [,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zito ^ c'•-I'7 I Co <br /> er?-11L 15.4-2xe2 CONTACT EMAIL: e r k �a ami r Cci <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 /> Owner/Authoriz Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />