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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,.EVERETT,WA 98201
<br /> (rr')425-257.8810 I FAX 425.257-8857 1(E)overetteps( everettwa,gov I www,everellwaagovfpermits
<br /> IP .OEOT SITE I; O A' TIO`-
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<br /> t PROJECT ADDRESS:
<br /> tt,_Ill 0, a A A, 4 .�. _A /BUILDING AREA;., � oitft
<br /> PROJECT TYPE: NI-W CONSTRUCTION _11AODIrION ENANT IMPROVMENT ...I REMODEL
<br /> ( BUILDING USE: t16,SFR EI TOWNHOUSE (J DUPLEX r.._]ADU Li MULTI FAMILY-It OF UNITS, _„ I ,OMMERCIAL
<br /> ' ELECTRICAL APLICA 'IO 'IATON ;ESPTION OF WORK
<br /> CONTRACT PRICE OF WORK � �50 ASSOCIATED BUIL PING PERMIT II(If applicable):
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<br /> C EE W
<br /> o E OF ORK,
<br /> �� 1 . ii 7-iiIKVC‘:.
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<br /> THIS INCLUDES SCOPE; (SELECT ALL THAT APPLY)
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING
<br /> I LINE VOLTAGE WORK? Fri NO YES Select Scope:❑ Service ❑ Feeder i✓I Circuits-#' , Complete Re-wire
<br /> f
<br /> LOW VOLTAGE WORK? NO [7]YES-#of Devices:;,,-,
<br /> i SELECT SCOPE(REOLiIRFD) n Data 1_,D Intercom El Thermostat n Audio r-,I Secure Access [1 Security System
<br /> I. El 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 /> { L_rr--J;.
<br /> Other(List fUl:
<br /> CODE COMPLIANCE
<br /> 1 IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: c✓ NO L YES--See Below&Pg .2
<br /> `. By checking this box,I air stating that I have read and understand all of WAC 296.468.900,selected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required because I nice(all of the following sub sections that do riot
<br /> ' Ste Page ii require Plan Rc view....
<br /> ARF YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE, t_KINO YE..S-See Below&Pg 3'
<br /> Pursuant to ROW 19,28 261,property owners and leaseholders cannot perform electricalwork err buildings for rent,sale;,or lease
<br /> w, without the proper electrical licensing and certification,or exemption.:By checking this box,I am spiting that I have completed and
<br /> Son Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> CONTACT INFORMATION
<br /> { OWNER NAMEe li�.'filliiiit TENANT BUSINESS AME(If Commercial";
<br /> OWNER MAILING ADORES: s Rr..t.r s ,T.
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<br /> Orr srr<x= y... � ��
<br /> T OWNER PHONt' •. +>F —•t • tii,m�l OWNER EMAIL: _
<br /> $:' vat.... 410, _ : . .....M.V.....,...... .... .-:..,
<br /> G 0NTRACTOR NAME: MERIDIAN CENTER ELECTRIC
<br /> I CONTRACTOR ADDRESS: sown,11109 66TH AVE
<br /> r:pe PUYALLUP srArr WA s 98373
<br /> CONTRACTOR P.HONE:360-419-05,30, CONTRACTOR EMAIL:MTVPRQDUCTIONMC.ELFCTRIC.COM,
<br /> CONTRACTOR NTRACTOR LIC Ii(IIPQt)diRF DI:MERIDCE3183G CITY OF EVERETT BUSINESS LIC.#tRt=0uIREC4Al, i (,, t,'c
<br /> PRIMARY CONTACT i IOWNER i,✓(ONTRACTOR I ,OTHFR(Pie ase Specify)
<br /> CONTACT NAME:„ ; PHONE'360-419-0'5580
<br /> �, CONTACT EMAIL:MTVPRODUCTION c1,MCFLECTRIC.COM
<br /> cl2EEMEN7•I hi why con dy"'Ttrnt 1 have.road andiLfwnaiLed fids rrp .#cab{so 8r€ii1 klri s 1815 seine to be true and coned. Ali provimips of taws,am/rind€'eaieyri ehb'9vvrdatir,Urns
<br /> .
<br /> type of work.will be c0rnpfet:d.,vh0lhrtr specified hrrr.�n or»01 The granting of a pvrmif does nor presume((.give authority to violate 0r renrel the provisions of any oilier slate or
<br /> ;0051 taw regulating conSrruciinn rix the,parfannarrce of Crinsti'ucl/6n '(hili I ern aulheritrsd by the owner of this properly Ili perform the work for Wi rich applrccrhun is(Pude and 1
<br /> comply wii.h rho Slate Corlrrctoii•Lav 115.2;IPCWenri 296 200 W/IC City of Everntt Ofliciel Usti Only
<br /> PERMIT 11
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