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161 ECTRICAL PERMIT APPLICATION <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 I(E)everetteps@everettwa.govI www.everettwa.gov/permits <br /> OJ,ECT SITE INFORMATION <br /> PROJECT ADDRESS: 2820 Oakes Ave. BUILDING AREA: N/A sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION 0 TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> ELECTRICAL APPLICATION INFO • <br /> CONTRACT PRICE OF WORK:$ 1500.00 ASSOCIATED BUILDING PERMIT#(if applicable): N/A <br /> DESCRIBE SCOPE OF WORK: <br /> Disconnect 2 existing roof top HVAC Units and reconnect new ones once they are in place. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ✓❑ Circuits-#:3 ❑ 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 /> L" E !. �• • P� •°, sue: <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 0 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: ENO EYES-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 /> CONTACLINFINt <br /> OWNER NAME: Klrtley Cole Associates TENANT BUSINESS NAME(If Commercial):Same <br /> OWNER MAILING ADDRESS: STREET 2820 Oakes Ave. <br /> CITYEverett STATE WA zip 98201 <br /> OWNER PHONE:N/A OWNER EMAIL:N/A <br /> CONTRACTOR NAME: SeahUrst Electric, Inc. <br /> CONTRACTOR ADDRESS: sTREET2915 Chestnut St. <br /> CITY Everett STATE WA zip 98201 <br /> CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL:dleblarlC@SeahUrst.com <br /> CONTRACTOR LIC.#(REQUIRED):SEAHUEI099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 18763 <br /> PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: I CONTACT PHONE:(425) 258-5143 <br /> Dave LeBlanc CONTACT EMAIL:dleblanc@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 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> ER <br /> ` \\O9 ` 711%,' <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page Application <br />