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• <br /> ELECTRICAL PERMIT APPLICATION <br /> 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 /> PI OJEC M"$flE INFORMATION , <br /> PROJECT ADDRESS: 1318 Hoyt Ave -1BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> ' E[ECTRICAI.APPLICATIQ14:RIFOI MATIONS ESCRIPTION opWOrtiC - . <br /> CONTRACT PRICE OF WORK:$ 8420 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install a new electric air handler. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? D NO ❑YES-Select Scope:❑Service Cl Feeder ❑Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO D YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data El Intercom ®Thermostat El 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): <br /> CODE.COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ 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: DNO 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 <br /> gyanexemption from this licensing/certification requirement. <br /> CONTAVT INFORMATIONeta ,i a 4",'', IN <br /> OWNER NAME: Patrick Poh TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1318 Hoyt Ave <br /> e,n Everett STATE WA zip 98201 <br /> OWNER PHONE:425-350-8193 OWNER EMAIL:13,130h@comcast.net <br /> CONTRACTOR NAME: Day and Nite Plumbing and Heating <br /> CONTRACTOR ADDRESS: STREET 16614 13th Ave W <br /> CITY Lynnwood STATE WA zip 98037 <br /> CONTRACTOR PHONE:425-775-6464 CONTRACTOR EMAIL:bryan@dayandnite.net <br /> CONTRACTOR LIC.#(REQUIRED):DAYNIPH944RQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019741 <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR EOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-350-8193 <br /> Patrick Po h CONTACT EMAIL:p,poh@comcast.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 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> L 7 r` E f /i — L,.. <br /> Owner/A horized Agent Signature DateRevised <br /> ( 1/11/2019) Page 1-Application <br />