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41 11 41 I <br /> II 1 1 I I 1 I <br /> Ill ELECTRICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8810 i FAX 425-257-8857 i(E)everettepsnmxmitres.gov i wo,wevorett,An gcvipenni(s <br /> 'PROJECT ADDRESS: CENTRAL MARINA G-DOCK G-20 BUILDING AREA: sq ft <br /> , <br /> PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION W TENANT IMPROVMENT LI REMODEL <br /> t <br /> ,SUILDING USE; El SFR Li TOWNHOUSE El DUPLEX 0 ADLI ID MULTI-FAMILY- OF UNITS: n't <br /> Li COMMERCIAL <br /> .... <br /> , ELECT= L APPLICATION INFO'4IIRATION'& DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 44.11111111V41111111if lir ASSOCIATED BUILDING PERMIT#(If applicable). <br /> DESCRIBE SCOPE OF WORK: <br /> ADD (I) 50 AMP CIRCUIT TO EXISTING RELOCATED BOAT HOUSE <br /> _ <br /> .THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> ' LINE VOLTAGE WORK? 0 NO DYES-Select Scope:El Service 0 Feeder 0 Circuits-#:1 El Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED):C1 Data 0 Intercom El Thermostat 0 Audio El Secure Access El Security System <br /> , <br /> 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional .Fire Alarm Permit is required for review of device location and installation approval. <br /> n Other(List All): <br /> 4 '••, CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION;INSTITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: 1Hyr NO „.. YES—See Below&Pg.2 <br /> By checking this box, I am stating that I have read and understand all of INAC 296-468400,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 /> Sea Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR wrrHour ELECTRICAL LICENSURE: %ENO DYES-See Below&Pg.3 <br /> F1 Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> I without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> see Pr-e signed the AFFIDAVIT on page 3 of-this application to receive an exemption from this licensing/certification requirement. g <br /> ONTACT111FORNIATMAI -. <br /> OWNER NAME: \PALTER SELDEN TENANT BUSINESS NAME(if Commercial); <br /> OWNER WAILING ADDRESS: srassr <br /> CAT, STATE .4? <br /> OWNER PHONE:425-239-0867 OWNER EMAIL: <br /> CONTRACTOR NAME: ROBs ELECTRIC INC <br /> CONTRACTOR ADDRESS: <br /> grReEr4405 103RD AVE SE ... <br /> .. <br /> cry, LAKE STEVENS iiTA IF WA , 98258 ,.....1 <br /> CONTRACTOR PHONE:425-334-6834 CONTRACTOR EmAIL:MICHELLEdROSSELECTRICINC.COM <br /> 1 <br /> CONTRACTOR UC.#(1REQuiRE0):ROBSET*110D0 CITY OF EVERETT BUSINESS LW.#(REQUIRED):025145 <br /> PRIMARY CONTACT: DOWNER ZCONTRACTOR DOTHER(Please Specify) „ <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this appkatIon and know the same to be true and correct. ARprovisiorys°flaws and ordinances-goys:17N this <br /> typo or work will be completed whether vecffled herein or not The granting ore permit does not presume to give aultimilly to violate or cancel Ma peovisiaiis b f any moar stale Of <br /> local law regulating construction orthe partortnan4:e of oorhsituction. That I anr authorized by the owner&this propettyto perform the work forwtsich application is made and 1 <br /> compty with tee State Contraetom Law 18.27 RGW Cod 296.200 WAC. City of Everett official Use Only <br /> PERMIT#: <br /> 7 0"' <br /> • <br /> q' I <br /> P .2 <br /> 4, -2 „,,,,L„,/ -"N L.,,, <br /> ,.. <br /> rawner/Authorized Agent Signatu Dni, fp,—tsed, wi.)..*::.;)igi Page 1 Application <br />