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01/18/2020 18 :50 44597 P. 001/001
<br /> L: ftECTRICAL PERMIT APPLI 'ATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WA HlNeTON (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsQeveretiwa.gov I www.everettwa,gov/permits
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<br /> PROJECT ADDRESS: 4410 RUCKER AVE J BUILDING AREA; _ sq ft
<br /> PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT LI REMODEL
<br /> BUILDING USE: CI SFR ci
<br /> `' � �,.�,,��_,;�._ .,._... , �-- MULTI-FAMILY UNITS: Q
<br /> TOWNHOUSE AMIL OF ✓
<br /> DUPLEXADU Y-# COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: . —
<br /> NEW CIRCUIT FOR HEAT PUMP IN CEILING
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO E YES-Select Scope: E Service D Feeder 17 Circuits-#:1 El Complete Re-wire
<br /> LOW VOLTAGE WORK? E NO ❑YES-#of Devices:
<br /> SELECT SCOPI=(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)_
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 7 NO ❑YES—See Below&Pg.2
<br /> Il By checking this box, I am stating that I have read and understand all of WAC 298.4b0-900,selected the specific reason on page 2
<br /> I I 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: ENO EYES-See Below&Pg. 3
<br /> LiPursuant 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.
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<br /> OWNER NAME: TOTEM RESTAURANT TENANT BUSINESS NAME(If Commercial);
<br /> OWNER MAILING ADDRESS: STREET 4410 RUCKER AVE
<br /> d rr EVERETT STATE WA yip 98203
<br /> OWNER PHONE:206.679.4510 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES &SERVICE
<br /> CONTRACTOR ADDRESS: STREET3601 EVERETT AVE
<br /> clry EVERETT STATE WA Zip 98201
<br /> CONTRACTOR PHONE:425.259.2161 JCONTRACTOR EMAIL:1Ceylander@yahoO.Com
<br /> CONTRACTOR LTC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363
<br /> PRIMARY CONTACT: DOWNER QCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: EAT CONTACT PHONE:425.231.2275
<br /> JC CONTACT EMAIL:icey)Bnder@yahoo.COm
<br /> AGREEMENT:/hereby certify that I have read and examined this application and know the seine to be true and oohed 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 Slat Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official use Only
<br /> PERMIT#:
<br /> /ee/ E
<br /> Own utharized Agent Signature Date (Revised 1/11/2 19) Page 1-Application
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