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ILECTRICAL PERMIT APPLILMTION
<br /> 47rCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 14th Street - Central A Dock Port Of Everett 'BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> . .. L, RJc;,.. PILI iION INFORMATION &,DESCI PTI NNI OF .,... r.:,.
<br /> CONTRACT PRICE OF WORK: $ 2,280.00 (ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Emergency Temporary Repair of Main Electrical Line
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ✓❑ NO El YES-Select Scope: El Service ❑ Feeder ❑Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? © NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat El Audio El Secure Access El 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 /> C y
<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO El 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: 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.
<br /> OWNER NAME: Port of Everett TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET P.O. Box 538
<br /> cin. Everett STATE WA ZIP 98206
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Service Electric Co., Inc.
<br /> CONTRACTOR ADDRESS: STREET P.O. Box 1489
<br /> CITY Snohomish STATE WA ZIP 98291
<br /> CONTRACTOR PHONE:360-568-6966 'CONTRACTOR EMAIL:sharon@secoinc.com
<br /> CONTRACTOR LIC #(REQUIRED):SERVIEC564RU 'CITY OF EVERETT BUSINESS LIC.#(REQUIRED)
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<br /> 029064
<br /> PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:360-568-6966 Ext#201
<br /> Sharon Card CONTACT EMAIL:sharon@secoinc.com
<br /> AGREEMENT.I 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 I am 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 and 296.200 WAC. City of Everett Official Use Only
<br /> PERMITil,
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<br /> Owner/Aufhoied Agent Signature Date (Revised 1/11/2019) Page 1-Application
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