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EIFCTRICAL PERMIT APPLY TION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 j FAX 425-257-8857 ((E)everetteps@everettwa,gov I www.everettwa.gov/permits <br /> ...d .. <JEet SITIE S:ORMATION <br /> PROJECT ADDRESS: 8315 5th Avenue West BUILDING AREA: 1,096 sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> ESE N INFORM ► _ ... . <br /> CONTRACT PRICE OF WORK:$ 6,907.00 ASSOCIATED BUILDING PERMIT#(if applicable): C1701-019 <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? ❑ NO []✓ YES-Select Scope: 0 Service El Feeder ElCircuits-#:15 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? El NO ElYES-#of Devices:3 <br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat El Audio El 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 /> El Other(List All): <br /> 3 �ZY`€. �«.6'-4OMP0ANC. a ” <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: CI NO ❑YES--See Below&Pg.2 <br /> By checking this box, I am stating that I have read and understand all of WAC 296-468-900,selected the specific reason on page 2 <br /> E. 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 /> L 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: Seattle Development Assoc., LLC TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 122 130th Street SE -#A <br /> CITY Everett STATE WA z 98208 <br /> OWNER PHONE:206-830-0126 OWNER EMAIL:SDAhomes@gmail.com <br /> CONTRACTOR NAME: Tughan Electric, Inc. <br /> CONTRACTOR ADDRESS: STREET1911 235th Court NE <br /> CITY Sammamish STATE WA ZIP 98074 <br /> CONTRACTOR PHONE:425-868-8072 CONTRACTOR EMAIL:Larry@tughanelectric.com <br /> CONTRACTOR LIC.#(REQUIRED):TUGHAEI943BP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044481 <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-830-0126 <br /> Ed is Kulaga <br /> CONTACT EMAIL:ediskulaga@grnaiI.com <br /> AGREEMENT:I hereby certify that I have read and examined tfris 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, e performance of construction, That J am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the St Contractor aw 18.27 RCW and 296.200 WAG. City of Everett Official Use Only <br /> Jr <br /> PERMIT#: <br /> .w 2 <br /> 5/20/2019 E <br /> Owner/ utho gent Signature Date (Revised 1/11/2019) Page 1-Application <br />