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<br /> CTRICAL PERMIT APPLI TION
<br /> EVERETT
<br /> CffY EVERETT
<br /> `�s
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 ( FAX 425-257-8857 ((E)evaretteps@everattwa.gov( vesw.everettwagovipennits
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<br /> PROJECT ADDRESS: 1614 Cedar ST ,BUILDING AREA: 196 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION D TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: D SFR
<br /> /�► El TOWNHOUSE El DUPLEX ❑ADU LI MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ ©,f�/ ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Adding electricity to detached shed
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO 0 YES-Select Scope:❑Service ❑Feeder ❑✓ Circ its-# mg Complete Re-wire
<br /> LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El 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 /> 3 << n.. :,,r!gam.t.`'.. ..,,s 'z x „a _, a.Y,IRM .3r..,k p ysgt AM , Srv.z„ t Z M. ;u .., S;=..m;:.s <,.srF; .. >``:x:`.
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: lei NO { YES—See Below&Pg.2
<br /> ❑ By checking this box, I am stating that Iv have read and understand ail of WAC 296-46B-900,selected the specific reason on page 2
<br /> of this application(see next page), j1171:1
<br /> D 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 /> 'v , 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 /> }n9AS,s n i._,t . .Nt..,,-. , td n.? .CONTA` IAC A11ONM, ."i.,u ,?. A) arenn, ,. ,.
<br /> OWNER NAME: Andrea Ide TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1614 Cedar St
<br /> cr,,. Everett STATE WA Z,P 98201
<br /> OWNER PHONE:425-802-3569 OWNER EMAIL:ideally2OO2@gmall.com
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> AGREEMENT:I hereby certify that t 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 lam authorized by the owner of this properly 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. Ci of Everett Official Use On
<br /> / / PERMIT#:
<br /> 1qt(6d
<br /> Andrea Id- LCL 8/25/19 E t '" --�-------
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page pplication
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