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LLECTRICAL PERMIT APPLIUTATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> OrETT <br /> PROJECT SITE INFORMATION:- <br /> PROJECT ADDRESS: 507 86th St SE BUILDING AREA: 1494 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑✓ REMODEL <br /> BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> ', CRIF OON OF WORK <br /> '' E1��CTRICA� . ..,... LIC�,TION,INI"�IRNIATION�..�,.,.... .:4.fi <br /> CONTRACT PRICE OF WORK:$ 2400 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> 200AMP Panel Change <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ✓❑ Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ 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 /> El Other(List All): <br /> _2'C. 4,0.DE COMPLIANCE, ,,,6 <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO 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 /> T..1.PW, rE IATILOtI 4 ... ''''...'":-":".':.'.,,,,A '%;,-40 <br /> 0 <br /> OWNER NAME: Mark Buster TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 507 86th St SE <br /> ,,n Everett STATE WA Z,, 98208 <br /> OWNER PHONE:425446-2392 OWNER EMAIL:msb2712@gmail.com <br /> CONTRACTOR NAME: Seatown Electric Corp. <br /> CONTRACTOR ADDRESS: STREET 3431 Broadway <br /> cn-y Everett STATE WA Z,, 98208 <br /> CONTRACTOR PHONE:425-270-1623 CONTRACTOR EMAIL:permits@seatownservices.com <br /> CONTRACTOR LIC.#(REQUIRED):SEATOEC821DG CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53916 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-270-1623 <br /> Be ka h Swanson CONTACT EMAIL:permits@seatownservices.corn <br /> AGREEMENT l 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 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> E Zoo ` a� <br /> 0 <br /> 1/6/2020 <br /> Owner/A horiz= GL•T nt Signature Date (Revised 1/11/2019) Page 1-Application <br />