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411 • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps©everettwa gov www everettwa.govipermits <br /> PROJECT SITE INFORMATION <br /> , (-7 <br /> PROJECT ADDRESS: 8307 5th Avenue West BUILDING AREA: 1,07 `---V.0 —3s,ft <br /> PROJECT TYPE: NE NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: E SFR 7 TOWNHOUSE El DUPLEX 0 ADU MULTI-FAMILY-#OF UNITS.I [7 COMMERCIAL <br /> ELECTRICAL APPLICATION INFORSWFONWRESOORTIONvolsvoRK <br /> CONTRACT PRICE OF WORK:$ 6,907.00 ASSOCIATED BUILDING PERMIT#(if applicable): C1701-011 <br /> DESCRIBE SCOPE OF WORK: <br /> Wire apartment to code, <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? Li NO 1,7 YES-Select Scope. ,Z Service [?] Feeder El Circuits-#:15 E Complete Re-wire <br /> LOW VOLTAGE WORK? Li NO YES-#of Devices:3 <br /> SELECT SCOPE(REQUIRED). 0 Data 0 Intercom Li Thermostat 7 Audio 0 Secure Access 0 Security System <br /> 0 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 /> E Other(List Ally <br /> -•,'"'Ot4,14446 . „ ,-IjAKtgkaraR,Kgtti, ,;.il;g4" <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [71 NO n YES--See Below&Pg.2 <br /> By checking this box,I am stating that I have read and understand all of WAC 296-4613-900,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 0YES-See Below&Pg. 3 <br /> Pursuant to ROW 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 /> ee Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> ;A-44.2,3jVc , <br /> OWNER NAME: Seattle Development Assoc., LLC TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1122 130th Street SE -cr-v #A <br /> Everett <br /> sTATE WA z„98208 <br /> OWNER PHONE:206-830-0126 OWNER EMAIL:SDAhomes@gmail,com <br /> . „.„ „ <br /> CONTRACTOR NAME: Tughan Electric, Inc, <br /> CONTRACTOR ADDRESS: sTREET1911 235th Court NE <br /> Sammamish SATE WA z, 98074 <br /> CONTRACTOR PHONE:425-866-8072 CONTRACTOR EMAIL:1-arrY@tUgharlBleCtrIC.COM <br /> CONTRACTOR LIC.#(REQUIRED):TIJGHAE19438P CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044481 <br /> PRIMARY CONTACT: EIOVVNER 000NTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-830-0126 <br /> Ed is Kulaga CONTACT EmAiLediskulaga@gmail.com <br /> AGREEMENT:I hereby certify that 1 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 <br /> comply with the St ontract Law 18.27 RCW arid 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#. <br /> 1/29/2019 E <br /> wner Auth gent Signature Date (Revised 1/11/2019) Page 1-Application <br />