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<br /> Ii ELECTRICAL PERMIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON ,R)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa,gov 1 www.everettwa.gov/permits
<br /> P. . PT SITE I 1RP ,
<br /> PROJECT ADDRESS: sill f 2 ° -6.,-11-tfiti trVil- t at i Z,',BUILDING AREA:._1 g 4'O
<br /> sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION TENANT iMPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: N<OMMERCIAL
<br /> .i;', RICALAke,PU" . IN, ._i t -aft , � ! oRK m }
<br /> CONTRACT PRICE OF WORK:$ , ,e , cv [ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: ��C�l�d 1
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO AYES-Select Scooee21Service ❑Feede rCircuits-#:
<br /> Gampiete Re-wire
<br /> LOW VOLTAGE WORK? NO ES-#of Devices: •
<br /> SELECT SCOPE(REQUIRED}: 0 Data El Intercom ❑Thermostat
<br /> ❑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 /> ,-2,. �v.�,.,, ;,. ,� . 1 DANCE A
<br /> IS THIS PERMIT EDUCATION ,NSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES ❑YES--
<br /> NO � � .el.•r
<br /> See Blow&Pg.2�
<br /> By checking this box. I am stating that I have read and understand all of WAC 296-46B 00,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: O O DYES-See Below&Pg.3
<br /> Pursuant to ROW 19.28261,property owners and leaseholders cannot perform electrical work• .uildings 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 /> 2 17 ... t CONTACT INFORMATION ,
<br /> OWNER NAME: edl��.Lf3e.-,., C �
<br /> �"(-, 11,,. TENANT BUSINESS NAME(If Commercial): i?�a,7.4 mar-
<br /> OWNER MAILING ADDRESS: STREET J ./ / /44, 11)Are. _
<br /> CITY 4.r"/I_ / '-°+f We (t49.- ZIP D}Z "
<br /> OWNER PHONE: — f, 3. OWNER EMAIL:C_.Lt;zg t-O yy c .� - ram .
<br /> CONTRACTOR NAME: , - y2.0 gi(Ott �"-, 1 /6 ,
<br /> CONTRACTOR ADDRESS: STREET ifICIr g1,f, (3 SZO
<br /> }�y �,ss�� .��f
<br /> CITY ✓F`,,mtc C�' �*t+ STATE 4«'V '. ZIP ? ,, '"`
<br /> CONTRACTOR PHONE:( )t49—rriCONTRACTOR EMAIL: i frer yet vb i' 8t. II f�,]1 c 11 , , : f4,.
<br /> CONTRACTOR LIC.*REQUIRED): e (t,�G? �I t/4�0J/4 CITY OF EVERETT BUSINESS LIC.#(REQUIR : j.0 t "-e to s','`
<br /> PRIMARY CONTACT: DOWNER ONTRACTORz +
<br /> CONTACT PHONE;(Please Specify)
<br /> ..d
<br /> DOTHER
<br /> CONTACT NAME:
<br /> "+wu+'*-� / k jar t,,,, CONTACT EMAIL:b q vvi,��^^
<br /> AGREEMENT:I hereby rtify that I have read and examined this application and know thesame to be 1ru4 and correct. Ail)rovisions 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 /> kc ,09 — 17 S
<br /> Owner/ orized Agent Sture Dat (Revised
<br /> 1/11/2019) Page 1-Application
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