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<br /> m ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASH I N GTDN (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I w.tw everettwa govfpermits
<br /> .•: •, ., .. . PROJEC1c S,T N RMA' LON ., SI B T E�°t„ i S /.
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<br /> PROJECT ADDRESS: 3114 Oakes Ave Everett, WA 98201 BUILDING AREA: 4676 sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ©TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: n SFR El TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ©COMMERCIAL
<br /> R ,ECTRICAt,APPLICATION INFORMATION & DESCRI MLW WORK'
<br /> CONTRACT PRICE OF WORK:$ 3900 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> a
<br /> Installing an AES radio to the FACP
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select S•+«.-. a Service ❑Feeder ❑Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑NO ❑✓ YES-#of D s:
<br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat Audio ElSecure Access E] Security System
<br /> © Fire Alarm-Installations under this perm" only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required or review of device location and installation approval.
<br /> El Other(List All):
<br /> ' CODE COMPLIANCE .,. i - `
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO D 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:EINO EYES-See Below&Pg. 3
<br /> 1. 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 t
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement
<br /> -- . , y CONTACT .. OR.. - r - ,
<br /> OWNER NAME: Lorraine Marie Black General Pei TENANT BUSINESS NAME(If Commercial): L Tl+ it 1
<br /> OWNER MAILING ADDRESS: S REIT 3114 Oakes Ave
<br /> can Everett STATE WA ztP 98201
<br /> OWNER PHONE:425.252,8518 OWNER EMAIL:Imblack117@yahoo"com
<br /> CONTRACTOR NAME: Guardian Security
<br /> CONTRACTOR ADDRESS: STREET 1743 First Ave South 1
<br /> orrr Seattle STATE WA ZIP 98134
<br /> CONTRACTOR PHONE:380.647.0110 x328 CONTRACTOR EMAIL:hmetour@guardiansecurity.com
<br /> CONTRACTOR LIC.#(REQUIRED):GUARDSS233K5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 0033443 -----) _ I.'
<br /> PRIMARY CONTACT: DOWNER QCONTRACTOR ❑OTHER(Please Specify)
<br /> -F)CCONTACT NAME: CONTACT PHONE:360,647.0110 x328 .1 I
<br /> 4
<br /> Heidi eto u r CONTACT EMAIL:hmetour@guardiansecurity.com t I
<br /> AGREEMENT I hereby certify that I have read and examined this application and know the same to be true and correct. Aft 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 tam authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the S ate Contractors Law 18.27 pCW and 296.200 WAC. City of Everett Official Use Only
<br /> h ,,, e/ PERMIT#: P,
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<br /> AGthorized Ag ligAglitire S 94e (Revised 1111/2019) Page 1-Application 1
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