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0 <br />E <br />EVERETT <br />WASHINGTON <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I movw.everettwa.gcv/perrnits <br />PROJECT [TO INFO—' -TION, S JRUA <br />PROJECT ADDRESS 5002 Narbeck Ave Everett, WA 98203 1BUILDING AREA: <br />PROJECT TYPE: EJ NEW CONSTRUCTION W1 ADDITION El TENANT IMPROVIVIENT El REMODEL <br />BUILDING USE: SFR 171 TOWNHOUSE El DUPLEX El ADU 1:1 MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />7 <br />CONTRACT PRICE OF WORK: $ 2,000.00 1ASSOCIATED <br />BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: <br />SOLAR PV INSTALLATION. 7.26kW <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THATLY) <br />LINE VOLTAGE WORK? El NO 0 YES - Select Scope: El Service 0 Fee er 91 Circuits-#-' El Z ❑ Complete Re -wire <br />LOW VOLTAGE WORK? El NO ED YES- # of Devices: <br />L—T-1 �_ <br />SELECT SCOPE (REQUIRED): El Data I—] Intercom ❑ Thermostat 1771 Au - 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 />❑ Other (List All): INSTALLATION AND WIRING OF SOLAR PANELS <br />CODE COMPLIANCE, <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO UYES -- See Below &Pg. 2 <br />17 By checking this box, I am stating that I have read and understand all of WAC 296-4613-900, ­t­t�d ct­ -,P--i- --a—, — p.g. 2 <br />Of tlh$S aQpj;cation (See —t AND Plan Review is NOT required because I meet all of the following subsections that do not <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CON] RACI OR WI THOUT ELECTRICAL LICENSURE: EINO MYES -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 h— — - pl­a . nd <br />See Page 3 -9,, AFFIDAVIT 3 <,t tr, I to receive an exemption from this licensing/certification requirement, <br />77, 77 '77,77 <br />ONTAC7, 77 <br />F 7 , <br />T 11,0MWR, 7", 7 7 <br />OWNER NAME: DAVIS, MITCH TENANT BUSINESS NAME (1, C_ <br />OWNER MAILING ADDRESS: STREET 5002 Narbeck Ave Everett, WA 98203 <br />cry Everett, WA 98203 STATE WA ziP 98203 <br />OWNER PHONE: 425-330-5906 <br />1OWNER EMAIL: <br />CONTRACTOR NAME: PROSTAT ELECTRIC <br />CONTRACTOR ADDRESS. STREET 1721 NE 64TH AVE <br />crry VANCOUVER STATE WA ZIP 98661 <br />CONTRACTOR PHONE: 503-539-7772_ <br />1CONTRACTOR EMAIL.: dale.krueger@comcast.net <br />CONTRACTOR LIC. #(REQUIRED): PROSTE*8900N <br />ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 62110 <br />PRIMARY CONTACT: DOWNER ZCONTRACTOR EJOTHER (Please Specify) <br />CONTACT NAME: <br />DALE KRUEGEICON-1 <br />CON FACT PHONE 503-539-7772 <br />ACT' EMAIL: dale. krueger@comeast.net <br />All "a „r , " I—, �, " < ,, —, " ,, r. 1 "111- ­­, rma <br />Th. ".h— <br />TI­ ....... <br />...... L­ 78,27 PCW 296 200 WAC U­ 0­, <br />PERMIT <br />412c E 2j2k2--- <br />Date (R­)­� 7/71/2079;' P. 9. 1-APP­­,nn <br />