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2-S.21/e61//0
<br /> 10:77- !LECTRICAL PERMIT APPLkuT1aON t,� 1
<br /> CITY OF EVERETT PERMIT SERVICES 35
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps(ceverettwa.gov� www.everettwa.gav/permits
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<br /> PROJECT ADDRESS:. CGLSrCA/bef fOR BUILDING AREA: WO'Z4e:orn/c sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> EL E CTR C : PPLI.CATI� °; . - . A . O: :. .:,;D ..:CRI ::: ...: I F�. ..
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<br /> CONTRACT PRICE OF WORK:$ 279'3/ 606 ASSOCIATED BUILDING PERMIT#(If applicable): r,
<br /> DESCRIBE SCOPE OF WORK: ( 4+; j! 4-v i2
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<br /> THIS INSTALLATION INCLUDES THE t OLL9WING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO Lail YES-Select Scope: Cl Service ❑ Feeder 0 Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? [ 10 ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio El 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):
<br /> .. ..:....:..
<br /> (S,THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑YES See Below&Pg.2
<br /> • ❑ 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 /> { I 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 /> 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 /> CONTRACTOR ADDRESS: STREET PO Box 46
<br /> Mukilteo CITY STATE WA ZIP 98204
<br /> CONTRACTOR PHONE:425-294-6944 CONTRACTOR EMAIL:Bridgett.Burns@kiewit.com
<br /> CONTRACTOR LIC.#tREQUIRED):GENERCC9840Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 040599
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<br /> PRIMARY CONTACT: DOWNER DCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-730-6546
<br /> Dennis Crow CONTACT EMAIL:Dennis.crow@kiewit.com
<br /> AGREEMENT:!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/am 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 /> • Art - St-Z.1-1c/-Z.1-1c/ E 101 D_ ) (5
<br /> Owner/Author 3d Agent S`gnature Date (Revised 1/11/2019) Page 1-Application
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