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.ECTRICAL PERMIT APPLI1 TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwagov I www.everettwa.govipermits <br /> WASHINGTON <br /> 1 PV1200I'*' IISRgPrtO4ECrtlf00*A1.1°r4 IPIiIIITIL <br /> PROJECT ADDRESS: 283f Colby Ave, Everett,WA 98201 BUILDING AREA: 16,000 sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: LI SFR 0 TOWNHOUSE Li DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> 0141410A1-APPU., 0$01141N01, .WOOK <br /> CONTRACT PRICE OF WORK:$ 37,707.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> - Low voltage class 1&2 HVAC and lighting controls <br /> -Add 11 Alternative circuits <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO El YES-Select Scope:El Service El Feeder El Circuits,*11 LI Complete Re-wire <br /> LOW VOLTAGE WORK? El NO El YES-#of Devices:158 <br /> SELECT SCOPE(REQUIRED): CI Data 0 Intercom El Thermostat El Audio 0 Secure Access El 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):HVAC and Lighting Controls <br /> PEZOMPUANCE, <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ILI NO Li YES—See Below&Pg.2 <br /> vor (E,tttchi-itsec.akpinpolicathitsionnox(,seaeI mnesxtattpinaggteTtAINhDavpelarenandealdvIv..linsdNerostTanreqd atlillreofdWbeAcaCu2s9e6I-4m6eeB-t900all,osfethleecroldlot:iiinegsspuebcificreasonon page 2 <br /> sectionsthat do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:EIND 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 /> J 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 /> 4.110,4,004404r4i1tgtitlAk7- 1411riMIM: <br /> OWNER NAME: Skodal TENANT BUSINESS NAME(If Commercial): Union Bank <br /> OWNER MAILING ADDRESS: amEET 2831 Colby Ave <br /> cm, Everett STATE WA 98201 <br /> OWNER PHONE:206-571-0101 OWNER Emmugary.larkin@maciniller.com <br /> CONTRACTOR NAME: Valentyn Peshko <br /> CONTRACTOR ADDRESS: sTREET2310 Market Street <br /> cn-y Mount Vernon STATE WA ,,, 98273 <br /> CONTRACTOR PHONE:360-630-7075 CONTRACTOR EMAILvalentyn@vppoweron.corn <br /> CONTRACTOR LIC.#(REQUIRED):VFELEES824DM CITY OF EVERETT BUSINESS LIG.#(REQUIRED):60180 <br /> PRIMARY CONTACT: 0OWNER ZCONTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-530-7075 <br /> Vatentyn CONTACT EMAIL:Valentyn@vppoweron.com. <br /> AGREEMEftJT I hereby car*that!have read and examined this application and know the same to he true and correct. All previsions 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 canoe]the provisions of any other stale or <br /> local law regulating construction or the performance&construction That!am authorized by the owner of this property to perform the work far which application is made and! <br /> comply with the State Contractors Law 1827 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT* <br /> Owner/Authorized Agent •ignature Date (Revised///1/2019) Page 1-Application <br />