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Num <br /> LLECTRICAL PERMIT APPLIUKTION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 730 112th st SW everett 98204 building D BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU MULTI-FAMILY-#OF UNITS: 12 ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ .}CC ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> repair feeder wires damaged by general contractor <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 /> ❑ 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 All): <br /> CODE COMPLIANCE <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: ENO 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 /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Sage Apartments <br /> OWNER MAILING ADDRESS: STREET 1730 112th St Sw <br /> CITY everett STATE wa zip 98204 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: core electric <br /> CONTRACTOR ADDRESS: STREET po box 2380 <br /> crTY woodinville STATE WA ,,,, 98072 <br /> CONTRACTOR PHONE:206-257-8554 CONTRACTOR EMAIL:joe@coreelec.net <br /> CONTRACTOR LIC.#(REQUIRED):coreeel864km CITY OF EVERETT BUSINESS LIC.#(REQUIR D): 053041 <br /> PRIMARY CONTACT: ❑OWNER ]CONTRACTOR ❑OTHER(Please Specify) 'f <br /> CONTACT NAME: CONTACT PHONE:206-257-8554 <br /> joe CONTACT EMAIL:joe@coreelec.net <br /> AGREEMENT:I 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 /> iF9i' -4,04^' 4/22/19 E \ 9 <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />