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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ll,---4 <br /> - y 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa gov I www everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 6133 Lake Chaplain Rd. BUILDING AREA: N/A sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: Q COMMERCIAL <br /> .... ELECTRICAL APPLICATION INFORMATION Si'DESCRIPTION OF WORK ,i,i ., 4i._. —,- : <br /> CONTRACT PRICE OF WORK:$ $3,500 ASSOCIATED BUILDING PERMIT#(if applicable): N/A <br /> DESCRIBE SCOPE OF WORK: <br /> Connection of a 2000KW Generator. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope:❑Service D Feeder ❑ Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System <br /> ❑ Flre 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 /> El 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: ONO OYES-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 en exemption from this licensing/certification requirement. <br /> `—'1,1,.:. 07'r,'CONTACT INFORMATION _ <br /> OWNER NAME: Mike Robinson TENANT BUSINESS NAME(If Commercial):COE-Water Filtration Plant <br /> OWNER MAILING ADDRESS: smsET 6133 Lake Chaplain Rd. <br /> cin, Monroe STATE WA „98272 <br /> OWNER PHONE:(425) 257-8203 OWNER EMAIL:mrobinson@everettwa.gov <br /> - <br /> CONTRACTOR NAME: Seahurst Electric <br /> CONTRACTOR ADDRESS: sTREET2915 Chestnut St. <br /> cme Everett STATE WA ria 98201 <br /> CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL:reception U©seahurst.com <br /> CONTRACTOR UC.#(REQUIRED):SEAHUEI099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425) 258-5143 <br /> Dave LeBlanc CONTACT EMAIL:dleblanc@sehurst,com <br /> AGREEMENT:/hereby certify that I have read and examined this appleatron 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 taw regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application Is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> V \' ' <br /> PERMIT#: <br /> EC, o?)�I % <br /> �' 3-26-19 . <br /> } 'ter' <br /> Ownsori! Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />