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08/07/2019 09:43AM 425744 DONALD 4VORTHAM, M. 1 PAGE 01/02
<br /> ELECTRICAL PERMIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 8x201
<br /> wnsr+iaosarl (P)425-251.8810 I FAX 425-257-8857 1(E)everetteps(,gevcrettwa.gov 1 www.everettwa.g/.fit
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<br /> PROJECT ADDRESS: 310 Olympic blvd Everett wa 98203 BUILDING AR A; 1800 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ RE •
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<br /> BUILDING USE: 1=1 SFR ❑TeUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY,#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRiCE OF WOR 7 $ 13000 MIMI ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF W
<br /> complete rewire WPA
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL TIIAT APPLY)
<br /> LINE VOLTAGE WORK? Cl NO E YES-Select Scope:❑Service ❑ Feeder ❑✓ Circuits-#:17 ❑✓ Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑NO ❑✓ YES-#of Devices:4
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ✓❑Thermostat Q 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 /> IS THiS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: l� NO ■ YES--See Below&Pg.2
<br /> fl 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: ru NO EYES-See Below&Pg.3
<br /> D 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: Mark stumpf TENANT BUSINESS NAME(If Commercial :
<br /> OWNER MAILING ADDRESS: STREET 310 Olympic blvd
<br /> CITY everett s-rATE wa 2ip 98203
<br /> OWNER PHONE:4253198217 OWNER EMAIL:
<br /> / ter,:., ,.:, ,,. .,.,,, ,.,_,,_nom. .� r:-- ,., , -
<br /> CONTRACTOR NAME: Marvel Electric
<br /> CONTRACTOR ADDRESS: s eET2511 center rd
<br /> cm everett STATE WS Zip 98204
<br /> CONTRACTOR PHONE:425 3301498 CONTRACTOR EMAIL:marvalelectricQgmail.Com
<br /> CONTRACTOR LIC.#(REQUIRED):MARVAEL831 DB CITY OF EVERETT BUSINESS LIC.#(REQUIRED:60166
<br /> PRIMARY CONTACT: DOWNER l CONTRACTOR ❑OTHER(Please SpecIly)
<br /> CONTACT NAME: CONTACT PHONE:425 598-5181
<br /> Marysol Valdivia CONTACT EMAIL:marvalelectric@gmail.com
<br /> AGREEMENT;I hereby certify that I have read and examined this application and know the same to be true and correct. Ali provisions of laws and ordinances governing WS
<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 i
<br /> comply with the State Contractors Law 18.27 RCW end 298.200 WAC, City of Official Usc onl.,„40 0q/c).71/9 y
<br /> PERMIT#:
<br /> E 050
<br /> Owner/Au orise Ageh Sign re Date (Revised 1/11/2019) Page 1-Application
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