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07/18/2013 08 : 37 #4318 P 001/001 <br /> • • <br /> Lol Illllllr ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(F.)everetteps®everettwa-gov i www.everettwa.gavlpermits <br /> WAeNlr+GroN <br /> .. "s�yt`r'''`�•?",. �, ;.�,`.1'.,3, 'a,_I`Y .. goys Trh1N,,ORMATIoN. <br /> PROJECT ADDRESS: 2936 COLBY AVE UPPER FLOOR NE UNIT (BUILDING AREA: sq ft <br /> PROJECT TYPE: Q NEW CONSTRUCTION ❑ADDITION Q TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 2 COMMERCIAL <br /> gcT i a A : LICATIQ Jwl MAT:I:ON &D 8CR1PTIaN OF 1f11ORK . . ,CONTRACT PRICE OF WORK:$ 7200 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> REWIRE 2ND FLOOR, EAST END, NORTH SIDE UNIT TO CODE_ NEW SUBPANEL IN UNIT, <br /> REPLACE PANEL FEEDING THE SUBPANEL. 1 STAGE OF A COMPLETE NEW SERVICE ( NOT IN THIS PERMIT <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO Q YES-Select Scope: ❑Service ✓❑ Feeder ❑✓ Circuits-#: Q Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): 0 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 /> .:,,.r: : a.J•.iY }h ky° n�or(List <br /> All): <br /> I ;,., ri .:7 � ��. +L�'�4[ i:2 .!;WMMQMrFaCifillTTikl11C1V�. n.Y,f.. .. � i i7 , ;.. .: ':;.'•'.' , '. <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO 0 YES--See Below&Pg..2 <br /> ❑ By checking this box,I am stating that I have read and understand all of WAC 288-448-900,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:QNO 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 /> • <br /> ... .....:..:"i..- - — - �_H'•Yi'r.aw <br /> F.+Z <br /> . ... ••,,- CE " TINIM�ORIIAAfi#Q _ <br /> OWNER NAME: BRITT MARIE LEE TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr 102�NORTHWEST 60TH ST <br /> CITY SEAT'LE STATE WA yp 98107 <br /> 07 <br /> OWNER PHONE:206.384.8481 OWNER EMAIL: . <br /> CONTRACTOR NAME: EYLANDER SALES & SERVICE <br /> CONTRACTOR ADDRESS: 5TRI:cT3601 EVERETT AVE <br /> _ crry EVERETT 5TATe WA zip 98201 <br /> CONTRACTOR PHONE:425.259-2161 CONTRACTOR EMAIL:iceylander@yahoo.com <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) - <br /> CONTACT NAME: CONTACT PHONE:425.231.2275 <br /> CORNY <br /> CONTACT EMAIL: <br /> AGREEMENT::I hereby certify that I have read and examined this application and know the same to be true and coned. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein ornot. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other stale or <br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and <br /> comply with the ate ontractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Ilea Only <br /> / r PEERRMIT : (� c <br /> Owne ut rized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />