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<br /> OrerrPLECTRICAL PERMIT APPLIU�TION
<br /> CITY OF EVERETT PERMIT SERVICES
<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.govlpermits
<br /> ...PROJECT SITE,IN O ., . :.:�:.:; ;:
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<br /> PROJECT ADDRESS: 1 O t.�>;.f I�f i l��t tic,/ +1'f 1 :BUILDING AREA: sq ft '
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION L.-ADDITION ❑TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> ELECTRIC 'PP ;.IC: T .:,.;;::;•;:.;: :: .,: ..,:
<br /> AL_A .. ...I,.... A :ION I . FQRMAT`ION���.R:ES:i�RIPT .QN7�OF:W4 .,K�:.:;.-:;:.:;•:;: :; : _ .;
<br /> CONTRACT PRICE OF WORK:$ . II Ma ASSOCIATED BUILDING PERMIT#(If applicable):
<br /> DESCRIBE SCOPE OF WORK: (A-1,i ) 4-11e e) r. .c p4-75 'YbS ... 1, 2
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<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO ❑YES-Select Scope: ❑Service IN Feeder ❑Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> :,. ❑ 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 /> (S THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO El YES--See Below&Pg.2
<br /> C 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO DYES-See Below&Pg.3
<br /> nII 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 /> .:...:....:...::
<br /> CONTAC, :.IIN OR - - -
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<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Boeing
<br /> OWNER MAILING ADDRESS: STREET PO Box 3707
<br /> city Seattle STATE WA zip 98124-2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: General Construction Company
<br /> vONTRACTOR ADDRESS: STREET PO Box 46
<br /> t•�,...
<br /> , CITY Mukilteo STATE WA ap 98204
<br /> CONTRACTOR PHONE:425-294-6944 CONTRACTOR EMAIL:Bridgett.Burns@kiewit.com
<br /> CONTRACTOR LIC.#(REQUIRED) GENERCC9840z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):040599
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<br /> PRIMARY CONTACT: DOWNER ©CONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: DennisCONTACT PHONE:206-730-6546
<br /> Crow CONTACT EMAIL:Dennis.crow@kiewit.com -
<br /> AGREEMENT::f hereby certify that 1 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!
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC, City of Everett Official Use Only
<br /> PERMIT#:
<br /> . a If/. 2,-(0-19 E \ck&2-. 02- 5 -
<br /> • rIAu h r ed A ignature Date (Revised 1/11/2019) Page 1-Application
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