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11111 <br /> r <br /> 411 <br /> LI ELECTRICAL PERMIT APPLICATION <br /> EV CITY OF EVERETT PERMIT SERVICES <br /> T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHiNGT0$ (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> e , PROJEWSITE'INFORMATION <br /> PROJECT ADDRESS: 1700 Marine View Dr Everett 98201 BUILDING AREA: sq ft <br /> PROJECT TYPE: NEW CONSTRUCTION El ADDITION E.]TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: El SFR ❑TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY #OF UNITS: 0 COMMERCIAL <br /> t,? . r'ELECTRICAL,APPLUCATION INFONIVIATIONAIDESORIPTION:OF WORK ° ;. :'„ .i.,a. <br /> CONTRACT PRICE OF WORK:$ 2000.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Rough in new hotel units on ground floor <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope:E Service El Feeder 0 Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑NO El YES-#of Devices:10 <br /> SELECT SCOPE(REQUIRED): 0 Data El Intercom 0 Thermostat ❑Audio El SecureAccess ❑Security System <br /> E l 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 /> El Other(List All): <br /> ,A , CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ❑YES—See Below&Pg.2 <br /> 7 By checking this box,I am stating that I have read and understand all of WAC 296-468-900,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. tit <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO OYES-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 /> ( I 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 /> INS RMA S <br /> CONTACT O TtQI�" �� f� �.��fed ��a"� ��,. <br /> OWNER NAME: Inn at Port Gardner TENANT BUSINESS NAME(If Commercial):Inn at Port Gardner <br /> OWNER MAILING ADDRESS: STREET 1700 W. Marine View Dr. <br /> cn~ Everett STATE WA zip 98201 <br /> OWNER PHONE:425-252-6779 OWNER EMAIL: <br /> CONTRACTOR NAME: Skyline Electrical Services <br /> CONTRACTOR ADDRESS: srnEEr9229 271st St NW #746 <br /> CITY Stanwood STATE WA uP 98292 <br /> CONTRACTOR PHONE:425-201-8288 _CONTRACTOR EMAIL:Wende@skylinelectriC.COm <br /> CONTRACTOR LIC.#(REQUIRED):SKYL1ES820RD CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60163 <br /> PRIMARY CONTACT: DOWNER I:CONTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425*2O1-8288 <br /> Alex CONTACT EMAIL:alex@skylinelectric.com <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ail provisions of taws 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 construcbon. That I am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> CD,...„ c� <br /> -2. E <br /> z -� <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />