7502 EVERGREEN WAY WELLS FARGO 2022-02-03

CONTRACT PRICE OFi WORK: S 7660.00 JASSOCIATED. BUILDING PERMIT* (if applicable): DESCRIBE SCOPE OF WORK: Exterior fighbiryg replacement and addit ons THIS INSTALLATION INCLUDES THE: FOLLOWING.SCOPE: SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ® No ❑ YES - Select Scope; ❑ Service [] Feeder © Circuits-#,: ❑ Complete Re -wire LOW VOLTAGE WORK? 0 NO: El YES- # of Devices: SELECT SCOPE (REQUIRED): 0 Data 0 Intercom Thostat [I Audits- Q Secure Access Security System ❑ Fire Alarm • InstailaFtions under this permit only indutle electrical. wiring rough -in of the system. An additional Fire Alarm Permit is required for review of device location andinstaliation approval. ® Other (list All): lighting upgrades ..,i2 IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: Vj NO YES— See Below, & Pg. 2 By checking this box, ! am stating that I have read and understand:.#I of WAC 296.464r9091.4fesW.1the specific reason on page 2 of this application (see next: page), AND Plan Review is NOT required because i meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTI7ACTt-1"HOtiT ELECTRICAL t tCtlitS: Np S-See,Below.+ Pg. 3 Pursuant to RCW.19.28.261, property owners and leaseholders cannot pedbrm electricca t work on buildings for rent, sets, or lease wlthout the proper electrical licensing and certification, orexemption. By shacking this box, I am stating that I have completed and See Pop 3 signed the AFFIDAVIT on page:3 of this applicatloo to receive en exemption fmm this licensinglcortification requirement: I F= 2W-737 43f CONTACT NAME: CONTACT PHONE: 089 i Kim Da ling[ catn/1cm-AtL-tein,,ita"m.,.#nrnr•s{ iiwn ry type of wore wN bo4wwWad whether'8pwbW how arnot nwgn xat few saw ru or" porfomemo. corrsbuctim, n the State Carrtnxtors Low 1827 RCW ,29#.M WAD. E l90cA — l Scanned with CarnScanner