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06/12/2019 08:36 3604740126 DONNELSON ELECTRIC INC #4046 P.001 /001
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<br /> _ECTRICAL PERMIT APPS;ATION
<br /> • CITY OF EVERL I ! PERMIT SERVICES
<br /> EVERETT - 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASK MGTeN (P)4255-257-88.10 I FAX 425-257-8857 1(E)everstteps@cverettwa.gov I vww.everettwa.gov/permits
<br /> a17 1\, .g r \ \\ mum bYlir
<br /> PROJECT ADDRESS; 10513- 3oTh J) SE BUILDING AREA: sq ft
<br /> PROJECT.TYPE: ❑NEW CONSTRUCTION El ADDITION ZI TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: 2c1 SFR n TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
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<br /> CONTRACT PRICE OF WORK: $J DO Q 0 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: Peco,1nmcT ry c c.e /i/G c.�✓y.-}
<br /> •
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPEr(SELECT ALL THAT APPLY)
<br /> UNE VOLTAGE WORK? n NO ❑YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: Z U Complete Re-wire
<br /> LOW VOLTAGE WORK? n NO ❑YES-#of Devices: •• •
<br /> SELECT SCOPE(REQUIRED): ❑ Data . ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System
<br /> ❑ Fire Alarm-InstalIations 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): •
<br /> ASWISAINI, Y 1`C1; \, F'tQ,t ;,�« �a,•\`;,` r 1 'h ,' WV "i l`"
<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES; K. NO • YES--See Below&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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: [NNO OYES-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:5 'i4 l ar/o/!0 hk. TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: seer /-OS/ 3011. DL Se
<br /> •/
<br /> e y Pre/y - CRY STATE J ZIP 9 O I
<br /> . OWNER PHONE: '1Z 37' �La..7 9 'OWNER EMAIL: -
<br /> CONTRACTOR NAME: 40,7,7e)fon e/ec lr,
<br /> CONTRACTOR ADDRESS: STREET 13e) /Z/ 4 v?
<br /> CITY 5TAT2 l✓54-. ZAP Cie zz3
<br /> CONTRACTOR PHONE:4/1S”23$-'470 CONTRACTOR EMAIL_jbj,9i5t9a . e/ecYriG v'.G©M •
<br /> CONTRACTOR LIC.#(REQUIRED),,®p»pe 0zrcalpe 1.9 OF EVERETT BUSINESS LIC #(REQuIRED):0.3/ 837
<br /> PRIMARY CONTACT: ❑OWNER VCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME; CONTACT PHONE: L/ Z3 _q'74" J
<br /> S '1 T Feels"r- C»-ict/cA/' CONTACT EMAIL: •
<br /> AGREEMENT.:I hereby certify that t have read and examined this application end know the same to be true and correct, All provisions of taws 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 /> /Deal law regulating constru - - e performan -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 ntrectors Law IP -r end 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#: .
<br /> gAh E - \000 - 0%5
<br /> •wner/Authorized Agent Signature Date (Revised 9/19/2019) Page 1-Application
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