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<br /> im ELECTRICAL PERMIT APPLICATION
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASH IMO Tot/ (P)425-257-8810 I FAx 42E407-8967 I(E)everetteps©everettwa.gov 1 totwv.everettwa„govioermits
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<br /> PROJECT ADDRESS: 1402 Rainier Ave. BUILDING AREA: 1800 sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: D SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL--a
<br /> CONTRACT PRICE OF WORK:$ 1,500 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> upgrading old i 00A zinzco panel to new breaker panel, adding furnace circuit
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:0 Service 0 Feeder 0 Circuits4:1 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO 0 YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data 0 Intercom ID Thermostat El Audio 0 Secure Access 0 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 /> 0 Other(ListAll):
<br /> is This PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Mil NO ill 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•reasort 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 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.
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<br /> OWNER NAME: Rosie Richardson TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1402 Rianier Ave.
<br /> Everett
<br /> CITY STATE WA zp 98201
<br /> OWNER PHONE:426-6i 2-7641 OWNER EMAIL:
<br /> CONTRACTOR NAME: Rhema Electric
<br /> CONTRACTOR ADDRESS: stREET626 S. Spruce St.
<br /> crly Burlington STATE VVA zip 98233
<br /> CONTRACTOR PHONE:360-391t-1884 CONTRACTOR EMAIL:daVOB@Themaelectric,com
<br /> CONTRACTOR Lie.#(REQUIRED):RHEMAEL94001.1 CITY OF EVERETT BUSINESS LIC.#(REDUIRED):45783
<br /> PRIMARY CONTACT: DOWNER DCONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: Al . CONTACT PHONE: 360-391-1884
<br /> Dave pa niz .CONTACT EMAIL: davea@thernaelectric.com
<br /> AGREEMENT:.!hereby certify that thrive 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 wet*wilt be compieted 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 /> 1 regulating COnantetiOn 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 /> met with State Contractors Law 18.27 RCVV and 298.200 WAC.tc_
<br /> City of Everett omelet Use Only
<br /> PERMIT*:
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<br /> 0 neriAnthe e Agent ignature Date (Revised 1/11/2019) Page'I-Application
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