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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P}425-257-0810 FAX 425-257-8857 (E)everettepseeverettm.cov www.everettwa,govipermits <br /> WASUlt401914 <br /> • ' AA*C * ,"°.--',4'140::),I1EZALI., ° i° ;,•q' <br /> PROJECT ADDRESS: 5505 EVERGREEN WAY BUILDING AREA sq ft <br /> PROJECT TYPE:- 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT ImpRovmENT El REMODEL <br /> BUILDING USE: 0 SFR U TOWNHOUSE 0 DUPLEX 0 ABU 0 MULTI-FAMILY-#OF UNITS: f:3 COMMERCIAL <br /> CT,117:::;C:ft:TAW;1:111P74"Tiff:!;:fliTt!,-4i'lkfiry4"jiTigfirM i05)70) <br /> CONTRACT PRICE OF•WORK:$ 2107 ASSOCIATED BUILDING PERMIT#(if applicable);$1907-003 <br /> DESCRIBE SCOPE OF WORK: <br /> Install LED retrofit lighting in (3)existing pylon signs and install one channel letter sign on building and <br /> connect to existing power. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO El YES-Select Scope:0 Service 0 Feeder El Circuits-#: 0 Complete Re-wire <br /> LOW VOLTAGE WORK? tEl NO 0 YES-#óf Devices: <br /> SELECT SCOPE(REQUIRED): ED Data 0 Intercom E1 Thermostat 0 Audio 0 Secure Access 0 Security System <br /> 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit It required for review of device location and installation approval <br /> C3 Other(List.Ail)Sign <br /> . -4• kra <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL-HEALTH AND/OR PERSONAL CARE FACILITIES. M NO 111 YES See Below&Pg.2 <br /> By checking this box,I am stating that I have read and understand all of WAC 29846E400,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:r1N0 DYES-See Below$k Pg.3 <br /> D <br /> Pursuant to RCW19.28.261,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,1 am stating that I have completed and <br /> Site page 3 signed the AFFIDAVIT on page 3 of this application to receive anexenvtion from tills licisneingicertifocation requirement. <br /> --•>•.•;'-v-q..r.FIT,r117:41tr'ilfi,J,I,,i771,7,1i917,9 <br /> OWNER NAME: HENS RUDE SCOTT T&CHRIS1 TENANT BUSINESS NAME(if Commercial):Caliber Collision <br /> OWNER MAILING ADDRESS: smEer 6130 MALTBY RD <br /> city WOODINVILLE ate%WA zip 98072 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Signs Plus Inc, <br /> CONTRACTOR sThEEr766 Mrine Drive <br /> oTy Bellingham •STATE-WA Z0 98225 <br /> CONTRACTOR PHONE:360-671-7165 ICONTRAOTOR EMAIL.; permitsesignsplusnw,com <br /> CONTRACTOR Lte.11(REQUIRED):EC SIGNSPI954LVV CITY OF:EVERETT BUSINESS LIC.#(REQUIRErnt 05278 <br /> PRIMARY CONTACT: DOWNER WI-CONTRACTOR DOTI-1ER(Pleaoe SPecifY)„ <br /> CONTACT NAME: • CONTACT PHONE:360-671-7185 <br /> Royce SievingCONTACT Efv1AIL:permItSesignSPluSnw.com <br /> .' <br /> AGREE/VENT:itierebycerti4,that i nave reed and examined this bPidierrilen end knew the same to-be Me end correct. All provisions of laws end ordinances governing this <br /> toe of work be completed whether specified herein or not The grenanti of pen if does not promo*10 ViktatitholitY to*tete Of CatiCeitUtProvisions of any other state or <br /> local law regoleting Onclerntion or the performance of coastruction. That lam authorized by the owner of this Polile)tY tO Perf000 the Welk ierw)ikhapphcalionJa made end <br /> comply with the Stela Contractors I ow 18,27 RCW end 296.200 lIVAC City of Everett°facto'Use Only <br /> PERMIT#: <br /> „woe <br /> 4/3,/5 <br /> E 0 -c)fl3 <br /> 0,140,5*. 6, <br /> Authorize Agnt gnaturyv Dale (Pevised 111 it201s) Page I-Application <br />