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10/23/2019 0 : 56 #4463 P. 001/001
<br /> ELECTRICAL PERMIT APPLAATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CFtAR STREET,EVERETT,WA 98201
<br /> wAsrop 'roN (P)425-257-,9810 I FAX 425-257-8857 I(E)everettepsOeverettwa.gov I www.everettwa.gov/pemtlts
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<br /> PROJECT ADDRESS: 1320 75th ST SW BUILDING AREA:
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<br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT ./❑ REMODEL
<br /> BUILDING USE: El SFR 1 TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: a COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 2000 ASSOCIATED BUILDING PERMIT#(if applicable);
<br /> DESCRIBE SCOPE OF WORK:
<br /> DECOMMISION EQUIPMENT/REROUTE CIRCUITS FOR BREAK AREA
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO 7 YES-Select Scope: ❑Service E] Feeder J❑Circuits4:3 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO El YES-#of Devices:
<br /> SELECT SCOPE(REQuIRED): El Data El Intercom ❑Thermostat ['Audio El Secure Access ❑ Security System
<br /> El 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 Alt)
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: E NO ❑YES--See Below&Pg.2
<br /> ' I By checking this box, I am stating that I have read and understand all of WAC 298-468-900,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 Pane 2 require Plan Review.
<br /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENODYES-See Below&Pg_3
<br /> ri Pursuant to ROW 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): ELECTRONETICS
<br /> OWNER MAILING ADDRESS: . SraaEr 1320 75TH ST.SW.
<br /> cm. EVERETT STATE WA zP 98203
<br /> OWNER PHONE:360.547.3188OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES &SERVICE
<br /> CONTRACTOR ADDRESS: sTREET3601 EVERETT AVE
<br /> ciTv EVERETT
<br /> STATE WA zea 98201
<br /> CONTRACTOR PHONE:425.259.2161 'CONTRACTOR EMAIL:jCeylander@yahoo.com
<br /> CONTRACTOR LIC.#(REQuiRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#REQUIRE()):016363
<br /> DOWNER ['CONTRACTOR PRIMARY CONTACT:
<br /> .`� TOR JOTHE I(Please Specify) `.w �.
<br /> CONTACT NAME:�C TOO CONTACT PHONE:425.231.2275
<br /> CONTACT EMAIL:jceylander@yahoa.Com
<br /> AGREEMENT I horsey car*that I have read and examined this application and know the same to he 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 conStnrction Or the performance of construction. That/am authorized by the owner Of this property to perform the work for which application is made and I
<br /> comply with t'e -tate Contractors Law 18,27 RCW and 298.200 WAC_ City of Everett Official Use Only
<br /> / PERMIT#:
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<br /> Ow `A `hurl•.'.Agent Signature Date (Revised 1/11/2014) rage 1-Application
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