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<br /> U CTRiCAL PERMIT APPLIW TIION O�� rOo`� �Q1 .
<br /> CITY OF EVERb!I PERMIT SERVICES
<br /> 7 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
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<br /> PROJECT,S:ITIE'.fNiF'ORLVaAT N,.. ;; ,
<br /> PROJECT ADDRESS: 40 `, 1 IE I S 3CO6 03 a \?aavytDI - 'l:Tr.: • sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> ,.. :'•• :••: ',•:`". Ei ECTRiCAL.APPL iICATi.O.N'I.NP.ORNIA,'TIO.I :&:D E S.0 ... !{ , ,. .:.: . ...._ . •
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<br /> CONTRACT PRICE OF WORK:$ I``fJ(000 0 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: c ,�� s-.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO gi4YES-Select Scope:L,Service ❑ Feeder ❑Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El 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 /> ?S THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO EI YES--See Below&Pg.j2
<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: ONO ❑YES-See Below&Pg.3
<br /> Pursuant to ROW 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.
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<br /> OWNER NAME: • TENANT BUSINESS NAME(if Commercial): Boeing
<br /> OWNER MAILING ADDRESS: STREET PO Box 3707
<br /> CITY Seattle STATE vv��1
<br /> A Z!P 98124-2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: General Construction Company
<br /> .ONTRACTOR ADDRESS: STREET PO Box 46
<br /> 1.
<br /> t, CRY Mukilteo STATE WA zip 98204
<br /> CONTRACTOR PHONE:425-294-6944 CONTRACTOR EMAIL:Bridgett.l3urns@kiewit.com
<br /> CONTRACTOR LIC.#(REQUIRED GENERCC984OZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED`):.-...,:040599
<br /> ..Tt+.•+a4RdL.�.z•.w,w..•._„y..,,�•+�..res,.-:.�,T..•.,..,�r•,.��.�6.K..r�._...«.,.—.«-wsaw:.rn�.-.,,..,:,�_.,.n:...:.,nsn�.w„..-...«�«,.�a'•"°.e,,�xw,..-,...�...n.-nm..•�s;, �sr 3^-v.c,..:.-..:mss.,...-.�..x�,>�,•.y, i
<br /> PRIMARY CONTACT: DOWNER DCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-730-6546
<br /> Dennis Crowi
<br /> CONTACT EMAIL:Dennis.craw@kiewit.Com
<br /> -AGREEMENT:t hereby certify that!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 C. tractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only i
<br /> #0 , PERMIT#: I
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<br /> Nit 1 � � 0 , 0 E ZcOL —oLc &Q
<br /> 'o :riAut .( od A.=nt Signature Date (Revised 1/11/2019) Page 1-Application
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