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CTRICAL PERMIT APPLIcA I ION
<br /> 07FETTCITY OF EVERETT PERMIT SERVICES
<br /> 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
<br /> PROJECTI"1'EJNFORMA 1O s. .r .
<br /> PROJECT ADDRESS: 332 St Everett Mall Way Bldg A BUILDING AREA: _ sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 6,680.00 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 1901323 16865 -Replacing (16) pole lights with LED
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO El YES-Select Scope: El Service El Feeder ❑✓ Circuits-#:2 El Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat El 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 /> El Other(List All):
<br /> E COMPLIANCE
<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO U YES--See Below.e pi, _ :,
<br /> &&Pg.2
<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: ✓❑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.
<br /> :. .•. -.its:.. ami . .. ��.. . �� f :,,iii,7 r�{. . XiKlt.\\. atH ........ .,. i
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: Titan Electric
<br /> CONTRACTOR ADDRESS: STREET 12828 Northup Way Suite 205
<br /> CITY Bellevue STATE WA zip 98005
<br /> CONTRACTOR PHONE:206.633.2811 CONTRACTOR EMAIL:Permits@titanelectric.net
<br /> CONTRACTOR LIC.#(REQUIRED):TITANEI9630B CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51191
<br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206.633.2811
<br /> Jon Osborn CONTACT EMAIL:permits@titanelectric.net
<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 18.27 R W and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> ,Y• \.,_) 9/3/2019 E\q pc0\/
<br /> J
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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