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zi Eit CTRICAL PERMIT APPLIgitTION <br /> EVERETT CITY OF EVERETT PERMIT SERVICEMP <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@eeverettwa.gov I www.everettwa.gov/permits <br /> PROJECT ADDRESS: )?.d0 jC S wee fj tpgrej3LQ(p / _BUILDING AREA: "'>5-00 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT KREMODEL <br /> BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 21 COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ Z Soca - — ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: Lk f ac_ L\Nctr R oe C,"-Com T --c11t f1 C-C- <br /> ('ti 1/1'--k 7v 1. _ A-0 n r LA) Is M A- G t Su& 7 .41 <br /> 00 PR-pi <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? G NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 7.11 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access Cl Security System <br /> It ire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> ire Alarm Permit is required for review of device location and installation approval. <br /> ❑ Other(List All): <br /> ,:d , ! s ,, ,,.;.,; aq e ,r',v�;."r .a »', '`„"''. t r .'� 9;✓"`•`"z'`'ry,,'”.av' ! +bJ ,,w„ ° x ;.x C <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES--See Below&Pg. 2 <br /> n 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"❑YES-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 /> OWNER NAME:hP e .(CA'1 (1167p t SCP-Vi C- S TENANT BUSINESS NAME(If Commercial): 61L i UA c C40) 14 6 <br /> OWNER MAILING ADDRESS: STREET//S- S Se- 6,-14- S J <br /> CITY )76-1-4- STATE LA-4711,- ZIP 9 O 06(4 <br /> OWNER PHONE: <br />