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ELLCTRICAL PERMIT APPLIC ON
<br /> CITY OF EVERETT PERMIT SERVICES
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<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.govipermits
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<br /> PROJECT SITE INFORMATION
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<br /> PROJECT ADDRESS:CP(1Di 0 &Ca e.-AA:aCkA4 T XLct.k.c..- .Q...- BUILDING AREA: sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION EI TENANT IMPROVMENT Vi REMODEL
<br /> BUILDING USE: X SFR C1 TOWNHOUSE 0 DUPLEX E1 ADU ill MULTI-FAMILY-#OF UNITS: El COMMERCIAL '
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<br /> AL' ' "PLICATION SipiK', ,' .-,',, .*IP:"ION OP WOR
<br /> .. . .., , . . ...--........, . . ..
<br /> CONTRACT PRICE OF WORK:$ 3'50 !ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: `.4.4"\Srfrk,\,\ ne,w .-ttitkicifY)(,) ttk,±.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? Cl NO [7 YES-Select Scope: EI Service El Feeder El Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO 21 YES-#of Devices: I
<br /> SELECT SCOPE(REQUIRED): E Data El Intercom 0 Thermostat 0 Audio El Secure Access 1E 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 /> ,
<br /> COPE COMPLIANCE . . . . .:44,0.43
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: kili.1 NO • YES-See Below&Pg.2
<br /> n By checking this box, I am stating that I have read and understand all of WAC 296-465-900,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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ri NO EYES-See Below&Pg.3
<br /> 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.
<br /> CONTACTINFOrtlTIOW-, -.. ',‘,k.‘. , _,-i'..,,,,,,..,
<br /> OWNER NAME::EvIrCI\AL, Ve.t-EC V1. TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET LO(g i 0I...A.:I0-- 4 k .....,(T-C.k.C4—,
<br /> CITY d 11.. / • STATE • ZIP (IT/0'
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: OVI (---tC,LA- aeC.A...+1.09. , yA/C
<br /> CONTRACTOR ADDRESS: STREET P,,,U CI-5)C —1()
<br /> crrY C'Ct\ CA t-t4 STATE UelitA ZIP et gcyLLI
<br /> CONTRACTOR PHONE:4-2:5 12:1- -I(.61-- CONTRACTOR EMAIL:(y-ifte(-cL 1 cei)c.A.‘t' -t4--- \#1\i Ct.C,c c.')tiln
<br /> CONTRACTOR LIC.#(REQUIRED):a itzri- t„-k-(133)6 ,CITY 6F EVERETT BUSINESS LIC.#(REQUIRED): IHS
<br /> PRIMARY CONTACT: DOWNER el CONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: i CONTACT PHONE: LA-t.cr) -2_ -2_.
<br /> 1,-VAC(/-\. CONTACT EMAIL:
<br /> /41
<br /> AGREEMENX. hensby certify that 1 have read and examined this application and know theme to be true and correct. All provisions of laws and ordinances governing this
<br /> type of w wi be completed whether specified herein or not. rhe granting of a permit does not presume to give authority to violate or cancel the previsions of any other state or
<br /> local la regul ting constructirn or 'performance of construction. That I am authorized by the owner of this property to perform the work for which application is made arid!
<br /> corn with e State C.;ontrai ors - 18.27 ROW and 296.200 WAG. City of Everett Official Use Only
<br /> PERMIT#:
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<br /> f-5011C1 E A \ n
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<br /> 0 ,n,r/Authorized Agent,i. attire Date (Revised 1/11/2019) Page'I-Application
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