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• i <br /> L; ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32 CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 0 N fiCt.E red BUILDING AREA: sq ft <br /> PROJECT TYPE: El NEW CONSTRU •N I ,,DDITION NJ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑ ?v. NHOUSE II DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL <br /> ELECT' AL APPLIC ION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK $ 2,' cx 00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF We''K: —176 `rv\C_: ce C` � 1t't' •f k ct"t ' <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO El YES-Select Scope:El Service El Feeder El Circuits-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO .®YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data El Intercom Thermostat ❑Audio El Secure Access ❑ 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 /> El Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑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 K,IYES-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: eK,A 1Gu it DeuottriiAtwir c. LL('LENANT BUSINESS NAME(If Commercial): Q Ch.�if ` <br /> OWNER MAILING ADDRESS: STREET 9C,r, <51,0 //,) 1 54/,A:- 300jj ^ <br /> CITY �'L�L'Y l ...... STATE tV);...... ZIP �.+L',1�..�'"`. <br /> OWNER PHONE: -�" OWNER EMAIL: P <br /> b,�� >4-'z7�:a:l G-c,cat <br /> CONTRACTOR NAME: A kA. r; 0(" l ccv,,k vac/c, <br /> CONTRACTOR ADDRESS: STREET p.,i( j(� - 0 /LrLi 3 33,&,ecytS£ {C <br /> CITY r'C:�„ ` -(.kc.,& STATE tf� ZIP Ct C:'3't <br /> CONTRACTOR PHONE:C(Z a `2'ZZ 7 0 q CONTRACTOR EMAIL: f , Lp> c, (Zak, �� _V\Vci ,, c(- <br /> CONTRACTOR LIC.#(REQUIRED): � -1 CITY O EVERETT BUSINESS LIC.#(REQUIRED)3(4SR <br /> 11 <br /> PRIMARY CONTACT: DOWNER (CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G.-t<'"Z S 1 7,7" 'I(0 `. <br /> -X\Jt ..� -\r\\ ) CONTACT EMAIL: eA, <br /> AGREEMENT:I r by certify that I have read and examined this application and know the Seine to be true and correct. All provisions of laws and ordinances governing this <br /> type of work w" be ompleted who er 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 reg ating nstruction or he 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 wit the S to Contractors Law 18.2 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> ,‘1. E <br /> Owner74[ithorized Agent Si a re Date (Revised 1/f1/2019) Page 1-Application <br />