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t LECTRICAL PERMIT APPLIPATION <br /> 46.77- <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT INFORMATIONr <br /> PROJECT ADDRESS: 6306 West Beech Street BUILDING AREA: 1474 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> litELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF,WORK <br /> CONTRACT PRICE OF WORK: $ 2500.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Panel replacement 200 amp <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO ❑ YES-Select Scope: 0 Service ❑ Feeder E Circuits-#: ❑ 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): New 200 amp panel <br /> CODE COMPLIANCE . <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: ❑✓ NO 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 /> CONTACT" , FORMATION <br /> OWNER NAME: Terri Johnson TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6306 West Beech Street <br /> Everett STATE WA Z,P 98203 <br /> OWNER PHONE:425-761-3265 OWNER EMAIL:teresajohnson898@gmail.com <br /> CONTRACTOR NAME: Good Sense Electric <br /> CONTRACTOR ADDRESS: STREET P.O. Box 421 <br /> CITY Mukilteo STATE WA ZIP 98275 <br /> CONTRACTOR PHONE:425-438-8738 CONTRACTOR EMAIL:carriew@goodsenseelectric.com <br /> CONTRACTOR LIC.#(REQUIRED):GOODSSE923D0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53371 <br /> PRIMARY CONTACT: DOWNER RICONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-438-8738 <br /> Dave/Carrie CONTACT EMAIL:carriew@goodsenseelectric.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 /> Carrie C.Willian 2/14/2020 / l <br /> Owner/Authorized Agent Signature Date (Revised 1/11/20/9) Page 1-Application <br />