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<br /> `i ECTRICAL PERMIT APPLIITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> 3 F s :: <<�00,0ti 11 5 i1 .` 14,-- 4111011114
<br /> PROJECT ADDRESS: 2132 GRAND AVE BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: EISFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE GAS FURNACE
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: El Service El Feeder ✓❑Circuits-#:1 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data El Intercom El Thermostat Cl Audio El 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 /> ❑Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LL 1 NO LJ YES—See Below&Pg.2
<br /> L( 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 DYES-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 /> { S.3 't" $�,_,� '., t �'F 1 C'...y� e6 S p `�! �y*.,Y,,i �sF` P 'tp k' Xy � Y `T -' 4FYf
<br /> .,,�..s':�. ,t' - $ ,� _ - f �'y` r rs., NX , 'A �O.RMA,.!'4KI� R�:;�,. v�' �' ca 3a z r v�et�g s� >E} n' 4 l�' -,,.x 3.., .r'.
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<br /> OWNER NAME: LLOYD WELLES TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2132 GRAND AVE
<br /> CIT, EVERETT STATE WA ZIP 98201
<br /> OWNER PHONE:425.350.0497 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES& SERVICE
<br /> CONTRACTOR ADDRESS: STREET3601 EVERETT AVE
<br /> CITY EVERETT STATE WA ZIP 98201
<br /> CONTRACTOR PHONE:425.259-2161 CONTRACTOR EMAIL:1Ceylander@yah00.COm
<br /> CONTRACTOR LIC #(REQUIRED) EYLANSS142LP CITY OF EVERETT BUSINESS LIC #(REQUIRED) 016363
<br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ✓❑OTHER(Please Specify)
<br /> CONTACT NAME: C M E 2 CONTACT PHONE:425.231.2275
<br /> CONTACT EMAIL:jceylander@yahoo.com
<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 lam authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with t S to r•ntractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> ///17/// E \ Olt Out
<br /> Own /Auth• 'zed Agent Signature atI (Revised 1/11/2019) Page 1-Application
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