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ECTRICALCITYOF PERMIEVERETTPERMT APPLI <br /> ITSERVICE. ATION <br />. 11114477. <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 <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 1 014 19th Ave SE, Suite 19A BUILDING AREA: 1,488 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: I_J SFR El TOWNHOUSE ❑ DUPLEX ❑ADU I1 MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 5,642 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Installing & Connecting 1 Illuminated Channel Letter Signs mounted on a raceway <br /> to existing 20 amp dedicated circuit <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: n Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: 1 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ 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 /> ❑✓ Other(List All):Channel Letter Signs mounted on a raceway <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 EYES-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: SKOTDAL BROTHERS LLC TENANT BUSINESS NAME(If Commercial): Bims Laundry Cafe <br /> OWNER MAILING ADDRESS: STREET 2707 COLBY AVE#1200 <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE:David Graef 425 252 5400 OWNER EMAIL: Dave.Graef©skotdal.com <br /> CONTRACTOR NAME: Skyline Electrical Services LLC <br /> CONTRACTOR ADDRESS: STREET26516 12TJ DR NW CITY Stanwood STATE V V,/�' <br /> A ZIP 98292 <br /> CONTRACTOR PHONE:425.923.0609 CONTRACTOR EMAIL:Jeremy@skylineelectric.com <br /> CONTRACTOR LIC.#(REQUIRED):EC SKYLIES82ORD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60163 <br /> PRIMARY CONTACT: ❑OWNER ECONTRACTOR EOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.923.0609 <br /> Jeremy Jensen CONTACT EMAIL:jeremy@skylineelectric.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 /> PERMIT#: <br /> 2/6/ZOZv E Zcc 2 - 0L3 <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />