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OECTRICAL PERMIT APPLI ,-.TION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www_everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 529 Sharon Crest, Everett, WA 98201 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL <br /> BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 13,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Kitchen and Bathroom Remodel <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 12 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <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): <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: ✓❑NO ❑YES-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: Jack Southwick TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 529 Sharon Crest <br /> „Ty Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-258-5811 OWNER EMAIL: jsouthwick@seahurst.com <br /> CONTRACTOR NAME: Seahurst Electric <br /> CONTRACTOR ADDRESS: STREET 2915 Chestnut St. <br /> CITY Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:425-258-1882 CONTRACTOR EMAIL:dford@seahurst <br /> CONTRACTOR LIC.#(REQUIRED):SEAHUEI099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 <br /> PRIMARY CONTACT: DOWNER UCONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-238-7724 <br /> Rob Layes CONTACT EMAIL: rlayes@seahurst.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 18.2 C—W a d 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> ( )A/C? <br /> r/AuthprizedJ�g�tSature Date 7 ( (Revised 1/11/2019) Page 1-Application <br />