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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 44111W' 3200 CEDAR STREET.EVERETT.WA 98201 <br /> (P)425-257.8,810 I FAX 425-257-8857 (E)everettep&8leverettwa gov www.everettwa goy/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2321 adams ave BUILDING AREA: tarn rink sq ft <br /> PROJECT TYPE: C.4*./]NEW CONSTRUCTION Li ADDITION El TENANT IMPROVMENT L] REMODEL <br /> BUILDING USE: fIZ SFR [Ti TOWNHOUSE DUPLEX Cl ADU Li MULTI-FAMILY #OF UNITS. El COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 350 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? [Ti NO El YES-Select Scope: Service El Feeder n Circuits*: Ci Complete Re-wire <br /> LOW VOLTAGE WORK? [..]NO CI YES-#of Devices. <br /> SELECT SCOPE(REQUIRED). Data IA Intercom El Thermostat Ti]Audio Ti]Secure Access El 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 /> Li Other(List All) <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND1OR PERSONAL CARE FACILITIES: 1:71 NO Li 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 EYES-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. <br /> CONTAcT,INFORMATION <br /> OWNER NAME: a and ED holdinas TENANT BUSINESS NAME(If Commercial: <br /> OWNER MAILING ADDRESS: STREET oc box 1395 <br /> owe take stevan's STATE wa ZP, 98258 <br /> OWNER PHONE:4253749205 OWNER EMAIL: <br /> CONTRACTOR NAME: orc electric <br /> CONTRACTOR ADDRESS: STREET 16708 b 41s1 dr ne <br /> arlinaton STATE wa ZIP 98223 <br /> CONTRACTOR PHONE:q .- ,.(i3()() vo CONTRACTOR EMAIL: 2N ,..\( tit kc A:141-kt t/{' <br /> CONTRACTOR LIC.#(REQUIRED). <br /> CITY OF EVERETT BUSINESS LIC.#(REQUIRED): t , <br /> PRIMARY CONTACT: DOWNER OCONTRACTOR OTHER(Please Specify) <br /> "1"C7-04:-LL-LS bTT PHONE:4253749205 <br /> CONTACT NAME:adrian <br /> CONTACT EMAIL:adrian.proelectric@).qmalLcom <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 con tructiOn"thiik pert/mance of construction. That!ern sot/ionized by the owner of this property to perform the work for winch application is made arid! <br /> comply with the tale s tract=Lew 18.27 RCW and 29.200 WAG. City of Everett Official Use Only <br /> PERMIT#: <br /> . , <br /> 2/2/1 E L90 2 - <br /> , <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />