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LLECTRICAL 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 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> OLT <br /> RC4EC1 OWE INFER <br /> PROJECT ADDRESS: 2119 Rainier Avenue BUILDING AREA: 572 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: ✓❑SFR ❑TOWNHOUSE E DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICAT i FORMATIO N &'DESCRIPTION OF,WOR ,n.;, , <br /> CONTRACT PRICE OF WORK:$ 10000 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Complete rewire and panel change <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO 0 YES-Select Scope: 0 Service ❑ Feeder ❑ Circuits-#: Z 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): <br /> coocoDkAPNIPU,N s <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO U 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 DYES-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 /> z C #NTAt ' INFORogt ! 7 y, <br /> OWNER NAME: April Williams TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2119 Rainier Ave <br /> civ Everett STATE WA Z,p 98201 <br /> OWNER PHONE:4253284938 OWNER EMAIL:asilverw@hotmail.com <br /> CONTRACTOR NAME: SeaTown Electric Corp. <br /> CONTRACTOR ADDRESS: STREET3431 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: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-905-4946 <br /> Beka h Swanson CONTACT EMAIL:permits@seatownservices.com <br /> AGREEMENT:1 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 /> (7 — <br /> 7/10/19 E10bl D(09)Owner/Authoriz d A ent Signature Date (Revised 1/11/2019) Page 1-Application <br />