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7 • •mim <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 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION . . . <br /> PROJECT ADDRESS: 13 I S— L A ,a 71>^. BUILDING AREA: tj`> 4 L sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ENANT IMPROVMENT El REMODEL t-1� <br /> BUILDING USE: CI SFR ❑TOWNHOUSE CI DUPLEX CI ADU CIy�MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATIElIr &;DESCRIPTION O ORK <br /> CONTRACT PRICE OF WORK:$ ' r COO ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: cu._\DCc4-7e (c\L- ,\,,c n t Y <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO e YES-Select Scope:❑Service ❑ Feeder ❑Circuits-#; V ❑Complete Re-wire <br /> LOW VOLTAGE WORK? El NO DYES-#of Devices: j 0 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access El 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 /> CODE°COMPLIANC ..; „. , <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: W"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: LINO 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 /> :: _ GONTART�INFORMATION <br /> OWNER NAME: ( Ceci 1 ec. ENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c•-•Ct) _c+� �}{�� �i/ , F� 39 rj(� <br /> CITY `� Cyr '! —� - STATE &" ' ZIP I OL1 <br /> OWNER PHON t tfa'_ Pe ^ OWNER EMAIL: <br /> CONTRACTOR NAME: ; L/mac--v-, _ <br /> CONTRACTOR ADDRESS: STREET - ( c0 L tD L E <br /> CITY �k,/\CA. 7S(./ , I L_ STATE ZIP C\0-7 <br /> CONTRACTOR PHONE: y ;): 1--C3y-CI /CONTRACTOR EMAIL: _S()`,Ps.. A- L � 1� <br /> CONTRACTOR LIC.#(REQUIRED):sC��LJ O L�S(c.� \ CITY OF EVERETT BUSINESS LIC.#(REQUIRED) <br /> \ ' 32 <br /> PRIMARY CONTACT: .OWNER ❑CONTRACTOR ['OTHER(Please Specify) � <br /> CONTACT NAME: CONTACT PHONE: L.i -- "3C 0 Z tom-,{0, <br /> �� CONTACT EMAIL: /o q �,�" v�TTC L <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 /> { -\ ) c) E2ciD1 - I �� <br /> O r/Authorize g Signature Date (Revised 1/11/2019) Page 1-Application <br />