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r <br /> urn CTRICAL PERMIT APPLICON <br /> CITY OF EVERE1T PERMIT SERVICES <br /> EVERETT 32CO CEDAR STREET,EVERETT,WA 98201 <br /> wxstrrttasoti (P)425-287-8810 I FAX 425,!57-8857 (E)everetteps@everattwa.gov;l www.ever tttwa.gov/Perrnits <br /> r 1 ` TROJE� atitiF ,5VM, 7. �...I'� <br /> PROJECT ADDRESS; 10121 Evergreen Way BUILDING ARE: SOO ....�sq ft <br /> PROJECTIYPE: 0 NEW CONSTRUCTION CJ ADDMON 0 TENANT IMPROVMEN1'i 0 REMODEL <br /> BUILDING USE: 0,SFR 0 TOWNHOpUSSE^�`,, .E DUPL 0 ADU 0y IMMUL11-FFrlAM11KY»#OF UNITS: 0 COMMERCIAL <br /> ELIt oT1 1C ,IA PL1CAT . RM TM .sAA <br /> � a71 1 i oNc —r .ate <br /> CONTRACT PRICE OF WORK:•8 3600 ASSOCIATED BUILDING PERMIT#;(if applicable): <br /> \DESCRIBE SCOPE OF WORK; <br /> LED retrofit parking.lot pole lights <br /> THIS STALLATION INCLUDES THS FOLLOW.NG SCOPE:(SELECT ALL THAT APPLY <br /> LINE VOLTAGE WORK? 2)NO 0 YES-Select Stupe:0 Service ❑Feeder 0 Circuits-#: 0 Complete Re-wire <br /> LOW VOLTAGE WORK? ( NO 0 YES-.#of Devices: <br /> SELECT SCOPE(REQUIRED);D Cl rata ©Irate,Intercom <br /> 0 Thermostat 0 Audio 0 Secure Ac e' 0- eq itv*stern <br /> 0 Fire Alarm-lnstaltatioris under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit fie required for review of device locationand installation approval, <br /> 0 Other(List All): _ <br /> r � <br /> SIS THIS PERMIT EDUCATION,INSTITUTIONAL.,HEALTH AND/OR PERSONAL CAR FACILITIES. F4 NO YES,-See Below&Pg.2 <br /> By checking this box,I am stating that I have read and understand all of WAC 298.488400,selected the specittp reason on page2 <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 WINO ES-See Below&Pg.3 <br /> ▪ Pursuant to RCW 1928261,property owners and teasehoiders cannot perform electrical'work on buildings for rent,sale,or lease <br /> • without-the proper electrical licensing and certification,or ekemptiion,By checking this box,1 am stating that I have completed and <br /> see> 3 signed the AFFIDAVIT on page 3 of <br /> this <br /> wapplication toreceive an exemption from this 8censindcertifcation requirement. <br /> \ 4 7. % r1CONTAcT"E■NFoR A oNl c av 1\7 l <br /> i< <br /> OWNER NAME th.C.„ 55LYTENANT BUSINESS NAME(If Gommercal):'South Point Plaza <br /> OWNER MAILING ADDRESS: stREET 10121 Evergreen Way <br /> Gay <br /> / Everett son WA zits 98204 <br /> OWNER PHONE: "' 0, .1-1440cvu OWNER EMNL9 j ® i VtSt11Tt aehr <br /> CONTRACTOR NAME: Mastercraft Eledtric, lnc. <br /> CONTRACTOR ADDRESS:, srn 1206 Frontage Rd N Ste.A2 <br /> ony Pacific since WA ZIP 98047 <br /> CONTRACTOR PHONtE 253-7374367 CONTRACTOR EM.Al�'9aryd rnastercraftlnc.ccrn <br /> coNTRAACTo .LIcn#(REoUlRED):MAST EI12'7B8 Cfl' 'OF I EREtT`BYSINESS I.ICr I' OIUlI Dt . 704 <br /> :.. A ..,.� .. .., F All <br /> PRIMARY CONTACT; CJOWNER (CONTRACTOR TIER(Please Specify <br /> CONTACT NAME:. CONTACT PHONE:206-295-0089 <br /> KIM DARLING G <br /> CONTACT�AACL:klritclCirlSStel CCaltirlC.GCS1tl <br /> AGREEMENT:f herebyaweleaid and examined this appilowon and know the sweet*be tare and correct Ad provision,of laws and crit_bees governing this: <br /> type of work ee completer/witetherspecirrad;herein or not. The gientkg granting' t permit-aloes not presume tog a authority to violate or cancel the previsions of any other elate or <br /> beat taw regulating dotted:re an or the performance srYoonetruction. That!amauthorhed by the owner of this property to peertonm the wog!far whidt a J catfcut 1s made and <br /> comply with t e to Contractors Law11127 RCW end 296,200 WAG.. City of Everett Official Use Only <br /> PERMIT* <br /> t/Vh 12/17119 <br /> (gnarl Agent Signature Date offeYlsed 1/11/2019) Page 1.Apptication <br /> Scanned with CamScanner <br />