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Num <br /> Loss ECTRICAL PERMIT APPLIg►TION <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�))everretteps@everettwa..�giov I www.everettwa.gov/permits <br /> R Ec y SITE'':.INFORMA"',IONM <br /> PROJECT ADDRESS: 8321 5th Avenue West BUILDING AREA: 1,096 sq ft <br /> PROJECT TYPE: Q NEW CONSTRUCTION [1 ADDITION El TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: El SFR ❑rTOWNHOUSE El DUPLEX ❑ADU Q MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> 'ArcINFORMATIONA Q+ j <br /> ON OF WORK-7 <br /> CONTRACT PRICE OF WORK;$ 6,907.00 ASSOCIATED BUILDING PERMIT#(if applicable): C1701-016 <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? El NO E YES-Select Scope: ✓❑Service ❑✓. Feeder El Circuits-#:15 ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices:3 <br /> SELECT SCOPE(REQUIRED): 0 Data El Intercom El Thermostat ❑Audio El Secure Access ❑ 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 /> n Other(List All): <br /> IS THIS PERMIT EDUCATION, :: ,. �+, ,I.,,, P ANcE,,..,.. .. ...., a, , R I <br /> INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO El YES—See Below&Pg.2 <br /> I 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 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: Seattle Development Assoc., LLC TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1122 130th Street SE - #A <br /> c,n Everett STATE WA ZIP 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 /> PRIMARYCON �� , avt � - <br /> TACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-830-0126 <br /> Edis Kulaga CONTACT EMAIL:ediskulaga@gmail.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 t ContractorgLaw 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 5/20/2019 E \oS <br /> OwnerlAuthoriz gent Signature Date (Revised 1/11/2019) Page 1-Application <br />