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ELECTRICAL PERMIT APPLIL,.TION
<br /> /%/ / 1/2/ CITY OF EVERETT PERMIT SERVICES
<br /> ��✓� t� 3200 CEDAR STREET, EVERETT,WA 98201
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<br /> PROJECT ADDRESS: 406 Mall Way (Parking Lot) No Suite # BUILDING AREA: ? sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION D TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: LI SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
<br /> CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: PARKING LOT LIGHTS& EXTERIOR LIGHTS(BUSINESS PLAZA)
<br /> • 20 ea 400w MH to 120w pole with direct mount bracket (8 on round poles, 12 on square poles)
<br /> • 7 ea 250w MH to 40w wp
<br /> • 7 ea 200w hps to 45w canopy
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder E Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? © NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ 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):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 51 NO • YES--See Below&Pg.2
<br /> nI I 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: ❑NO 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.
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<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: R V B ELECTRIC&CONSTRUCTION INC
<br /> CONTRACTOR ADDRESS: STREET2803 GRAND AVE
<br /> CITY EVERETT STATE WA zip 98201
<br /> CONTRACTOR PHONE:425-344-9180 CONTRACTOR EMAIL:OFFICE@RVBELECTRIC.COM
<br /> CONTRACTOR LIC.#(REQUIRED):RVBELVB841M8 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 55896
<br /> PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-344-9180
<br /> ROMAN BOYARCHUK CONTACT EMAIL:OFFICE@RVBELECTRIC.COM
<br /> AGREEMENT.I hereby certify that I 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 Contractors Law 1:-.r:»'•and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> E ic; .1D(A
<br /> 4/10/19
<br /> Owner/Authorized Agent Signature Date (Revised 1/112019) Page 1-Application
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