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• 4111) <br /> ELECTRICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 42y5--257-88557i�I(E)everetteps@everettwa.goovv I wwweverettwa.gov/perrnits <br /> _Plfi'41141 r>yr��;{ IIo$ <br /> `Tnq!T!� '�MS!,,�.�����^. .�. .._. _ ... <br /> PROJECT ADDRESS: 2402 Chestnut St BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: El SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> �iy O <br /> CONTRACT PRICE OF WORK: $ 1800 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install 120V 20amp dedicated circuit for blower motor of cook top fan <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO El YES-Select Scope: El Service El Feeder ❑✓ Circuits-#: 1 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑NO El YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ intercom ❑Thermostat ❑Audio ❑ Secure Access <br /> ❑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 /> 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: ENO EYES-See Below&Pg.3 <br /> i <br /> 7 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 /> • <br /> .,l rd zit,. z )'i4= a ,.7 •..� ",,. ,r , r u <br /> OWNER NAME: Kelly Royal TENANT BUSINESS NAME(If Commercial) <br /> OWNER MAILING ADDRESS: STREET 2402 Chestnut St <br /> cm, EVERETT STATE WA zip 98203 <br /> OWNER PHONE: (206) 779-3361 OWNER EMAIL; kelly@ryalit.com <br /> CONTRACTOR NAME: PARKER BROS ELECTRIC <br /> CONTRACTOR ADDRESS: STREET 13630 54TH DR NE <br /> cirr MARYSVILLE STATE WA „P 98271 <br /> CONTRACTOR PHONE:425-239-6319 CONTRACTOR EMAIL: admin@parkerbroselectric.com <br /> CONTRACTOR LIC.#(REQUIRED): PARKEBE845NT CITY OF EVERETT BUSINESS LIC. REQUIRED):56709 <br /> •PRIMARY CONTACT: DOWNER ❑CONTRACTOR 'JOINER(Please Specify) OFFICE ADMIN <br /> CONTACT NAME: CONTACT PHONE:360-572-0108 <br /> Natalie CONTACT EMAIL: admin@parkerbroselectric.com <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Al!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 298.200 WAG. City of Everett Official Use Only <br /> PERMIT#: <br /> 11/25/2019 E I 1 <br /> Own ertAuthprized A ent Signature Date (Revised 1/1 11201 9) Page 1-Application <br />