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<br /> -- CTRICAL PERMIT APPLI TION �� -., •
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@eviarettwa.gov I www.everettwa.govtpermits
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<br /> „ ....:. IPR0JEt{ SIT�;�II�:Fa . .1�1AT1,ON:°,`�':! ;;:'';•''•
<br /> PROJECT ADDRESS: 1--)0- rletttki�a0� S'i M1 1-1---r BUILDING AREA: - .sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑blDITIION ❑TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> .t."'''::'''''''';;':!:::',:':::. .:- ELECTRICAL APPLICATION NFOR TIO &SDESC
<br /> R1PTowOFWORK::.. , ;,,` .;`• ; ;.: . '..
<br /> CONTRACT PRICE OF WORK:$ 2(p/ cioa ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: 't t t{rn VVU 4l S
<br /> rot/0"e_ .O( ir'" -Co( 0 eh 1)(1'6\s
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<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0,�,,,'NNCrO ❑YES-Select Scope: ❑Service U Feeder ❑Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? L1dQ ❑YES-#of Devices:
<br /> • SELECT SCOPE(REQUIRED): ❑ Data ❑Intercom ❑Thermostat ❑Audio 0 Secure Access ❑Security System
<br /> : . 0 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 /> • . ODE-401Ip.L > ::
<br /> 0.A THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: �1 NO I YES-•
<br /> See Below&Pg.2
<br /> By checking this box, I am stating that 1 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: NO OYES-See Below&Pg.3
<br /> — Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buil Ings 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 /> o TAC ANFO
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Boeing
<br /> OWNER MAILING ADDRESS: STREET PO Box 3707
<br /> ant Seattle STATE WA zip 98124-2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTORNAME: General Construction Company
<br /> 6ONTRACTOR ADDRESS: STREET PO Box 46
<br /> F•
<br /> oiMukllteo STATE WA ZIP 98204
<br /> CONTRACTOR PHONE:425-294-6944 CONTRACTOR EMAIL:BridgettSp .Bums@kiewit.com
<br /> CONTRACTOR LIC.#(REQUIRED):GENERCC984Oz CITY OF EVERETT BUSINESS LIC.#(REQUIRED):040599
<br /> �k�. �....,• - � �. �, . x., ._.-�.»» „�� ova a. a
<br /> PRIMARY CONTACT: DOWNER ©CONTRACTOR ❑OTHER(Please ecify)
<br /> CONTACT NAME: CONTACT PHONE:206-730-6546
<br /> Dennis Crow CONTACT EMAIL: STATE
<br /> AGREEMENT.'I hereby certify that!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 ofher state or
<br /> local law regulating construction or the performance of construction. That 1 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#:
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<br /> -OwneriAuth0rik'ed Agent Signature Date (Revised 1/11/2019) Page 1-Application
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