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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT.WA 98201 <br /> HN"' 425-257-8810 1 FAx 425-257-8857 I rEi everetteps@everettwa goy www everettwa.govigermits <br /> NiAhnN <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2223 1/2 Wetmore Ave#5 BUILDING AREA: sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION Li TENANT IMPROVMENT CI REMODEL <br /> BUILDING USE: El SFR El TOWNHOUSE El DUPLEX El ADU 21MULTI-FAMILY-#OF UNITS: E COMMERCiAL <br /> MILACTRICAliiARPMPATIOliii INFORMATION & DESCRIPTI <br /> 7 - <br /> CONTRACT PRICE OF WORK;$ I 100 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install altered 100 Amp service for Bunglow#5 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ID NO El YES-Select Scope:0 Service 0 Feeder 0 Circults-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data CI Intercom El Thermostat El Audio El Secure Access 0 Security System <br /> 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 /> El Other(List All): Alter service <br /> ' . <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ED NO 0 YES—See Below&Pg. 2 <br /> By checking this box,I am stating that I have read and understand all of WAC 296.4613400,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 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 exemption from this licensing/certification requirement, <br /> COWIr <br /> OWNER NAME: B&M Enterprises LLC TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET 2223 1/2 Wetmore Ave <br /> cm, Everett WA 21 98201 <br /> OWNER PHONE: 206 376-9927 OWNER EMAIL: <br /> CONTRACTOR NAME: Boyer Electric Company Incorporated <br /> CONTRACTOR ADDRESS: sTREEr 8119 240th St SW <br /> ary Edmonds 'i/,rt WA 98026 <br /> CONTRACTOR PHONE: 206 367-7606 [CONTRACTOR EMAIL: karen@boyerelectric.com <br /> CONTRACTOR LIC.#(REQUIRED); BOYEREC101LE iCITY OF EVERETT BUSINESS LIC,#tREoutetEo): 22147 <br /> PRIMARY CONTACT DOWNER OCONTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 367-7606 <br /> Karen Hanson CONTACT EMAIL: karen©DuyereleCtriC.COm <br /> AGREEMENT-I hereby certify that I have rood end examined this application ono know the same to be true and correct. Al/provisions of laws and ordnances governing <br /> type ofwork we be completed whether specified herein or nor The grunting of a permit does not presume to give authofity to violate or cancel the povfoloirs of any ether state or <br /> local law regulating construction or the performance of construction. ThaU am authorized by the owner of this property to perform the wor*for which eacilication is made and <br /> comply with the State Contractors Law 1&27 RCW end 298.200 WAC city of Everett C:iftteial Use Only <br /> 281_1. PERMIT#: <br /> B <br /> E 1q <br /> OwntirrAutherized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />