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08/14/2019 08 : 30 #4361 P. 001/001
<br /> ._._ECTRICAL PERMIT APPLu ATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CE=DAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www,evurettwa,gov/permits
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<br /> PROJECT ADDRESS: 2306 GALE PLACE ;BUILDING AREA: sq,ft
<br /> PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT O REMODEL
<br /> BUILDING USE: 0 SFR ❑TOWNHOUSE El DUPLEX LI ADU ❑ MULTI-FAMILY #OF UNITS: ©COMMI-RCIAL
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<br /> CONTRACT PRICE OF WORK:$ 2600 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE SERVICE PANEL. WITH 200 AMP MAIN BREAKER PANEL USING 100 AMP FOR MAIN BREAKER.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO Q YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? ,ZNO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data LI Intercom ❑Thermostat ❑Audio ❑Secure Access ❑ Security System
<br /> 0 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 AIL):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: PI NO ■ YES--See Below&Pg.2
<br /> Gr
<br /> nBy checking this box, I am stating that I have read and understand all of WAC 29l-465-900,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: ❑✓ NO EYES-See Below&Pg.3
<br /> n 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: Merrilee Obrien TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET PO BOX 595
<br /> cly MARYSVILLE _ STATE WA ap 98270
<br /> OWNER PHONE:425-61.38321 OWNER EMAIL:
<br /> •
<br /> CONTRACTOR NAME: FYI-ANDER SALES & SERVICE Y f
<br /> CONTRACTOR ADDRESS: sTREET3601 EVERETT AVE
<br /> my EVERETT STATE WA P 98201
<br /> CONTRACTOR PHONE:425-259.2161 CONTRACTOR EMAILaCeylander@yahOO.COm
<br /> CONTRACTOR L1C.#(REQuIRED):EYLANSS142LP CITY OF EVERETT BUSINESS L1C.#(REQUIRFO):01636.3
<br /> PRIMARY CONTACT: [OWNER ❑CONTRACTOR ❑✓OTHER(Please ST mow
<br /> CONTACT NAME CONTACT PHONE:425.231.2275
<br /> corny 1st CONTACT EMAIL:jceylancler@yahoo_corn
<br /> AGR,EEMEN ,thereby certify that I have read and examined this application and know the same to be true and actinic:, 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 em authorized by the owner of This propertyto perform the work for which application is made and I
<br /> comply wlh he state Contractors Law 18.27 RCWand 296,200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> 1/ . {ey , E °I DS Z
<br /> O..' -r/•u horiz 'gent Slgnat re Data r
<br /> (Revised 1/11/2019) Page 1-Application
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