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ELECTRICAL PERMIT APPLICATION <br /> �'� C1TY.OF EVERETT PERMIT SERV.IgES <br /> 11.^ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425.2574810 I FAX.425-257-0857 I(E)everetteps everett va gpv I erimevetethmgoviperrnils <br /> PROJECT ADDRESS: 2721 Fulton ST Everett 98201 >3u Lois AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRDPTION: 0 ADDITION 0 TENANT IMPROVMENT ✓C]REMODEL <br /> BUILDING USE: d SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU. 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> "• LECT RIC AP.ucAreti gi, . .`,•. DEE, ' rlO 1 WORx : , <br /> CONTRACT PRICE OP WORK:$ 800 ASSOCIATED BUILDING.PERMIT#(If applicable); <br /> DESCRIBE SCOPE OF WORK: <br /> 15 amp circuit only for furnace _. <br /> HIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:0 Service 0 Feeder 0 Circuits4:1 0 Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED):0 Data 0 intercom 0 Thermostat 0 Audio 0 Secure Access 0 Sew*,System <br /> 0 Fire/Maim-Installations under the 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 /> 0 Other(List AIl) <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ® NO '®YES--See Below&Pg:2 <br /> El By checking thia-tmx,.I am stating that I have read and understand all of WAC 296.463400,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 /> rT <br /> ARE YOU AN OWNER PERFORMING WORK,AS THECONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO OYES-See Below&Pg.3 <br /> Pursuant to RCW 1928.261,property owners and leaseholders cannot-perform electrical work on buildingsfor rent,sale,or lease <br /> without the proper electrical licensing and certification,.or exemption.By checking this box,-I am stating that 1 have cottrptetett and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirements <br /> q <br /> oma+{' , I!1 �INIFORMA I1rw11 ?„ ,:�w, ` Are` <br /> OWNER NAME:Gary Thompson TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear 2721 Fulton ST <br /> ,,,,.r Everett arm WA ,98201 <br /> OWNER PHONE:na OWNER EMAIL:fla <br /> CONTRACTOR NAME: In House Electric <br /> CONTRACTOR ADDRESS: sTREET1530 117th DR`SE <br /> nn, Lake Stevens STATE WA zta 98258 <br /> CONTRACTOR PHONE:4257603203 (CONTRACTOR EMAIL:ihepermits@gmail,COrn <br /> CONTRACTOR LIC.O REQUIREp):inhaueS852gg CITY OF EVERETT BUSINESS LIC,#(REQUIRED,044168 <br /> PRIMARY CONTACT: "®OWNER 1 CONTRACTOR OQTHER(Please:Specify) <br /> CONTACT NAME: CONTACTPHONE:425750$203 <br /> Kelsey CONTACTEMAIL:ihepet iits@gmail,ram <br /> AGREEMENT:i hereby certify that I haveread endii anima this application and know.the same tete tare and'correct,;Ali provl rns of from anclordioancesgovermag ens <br /> type of work•wifi b- mpleted wh er s! - in ormat.-The granting of a(remit does not presume to give euthOthy to violate or cancel the:p,avisions ofany°therdtate,or <br /> locallaw reg ng•. ruction• the. •.if: : ,(construction. That am authorized by the owner o/this property to perform The work tar'wh our application is made I <br /> oumpty,.: the•S :e Contra T8 2J296200WAG.- City of Everett OfficialUse 9niy <br /> PERMIT# <br /> /2,,,7 <br /> z <br /> �,iffdAid E t°103-- E,ca3 <br /> Owner/ r .rized eir ntS•rtatu " Date (Revised 1/11/2019) Page 1-Application <br /> Scanned with CamScanner <br />