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4110 <br /> • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT WA 98201 <br /> • <br /> (F)425-257-8810 I FAX 425-257-8857 i(E)evereitops@everettwa,gov( www,everetlwa.go+dpermils <br /> PROJECT SITE INWN TIIO <br /> PROJECT ADDRESS: "` ' 00 JL .C• BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: G SFR El TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS,,,,, ,,,, 7 COMMERCIAL <br /> ELECTRICAL.APPLICATION INFORMATION ON &:DEE-CRIPTION OF WORK <br /> a <br /> CONTRACT PRICE OF WORK:$ 8 OO Y , ASSOCIATED BUILDING PERMIT#(if applicable); <br /> DESCRIBE SCOPE OF WORK: fAtfe feel ( 1 -" � - ' I ( ts1 <br /> TENANT IMPROVEMENTS <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY), ; <br /> LINE VOLTAGE WORK? ❑ NO 7 YES-Select Scope ❑Service ❑ Feeder E Circuits-#:2— U Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices. <br /> SELECT SCOPE(REQUIRED). LI Data 0 Intercom ❑Thermostat ❑Audio LI Secure Access ❑Security System <br /> ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system..An additional <br /> li Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ®✓ NO El 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: ✓ONO -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 rece've an exemption from this licensing/certification requirement, <br /> CONTACT INFORMATION <br /> OWNER NAME �fe,[, 40a Rxriv <br /> TENANT BUSINESS NAME(If Commercial), ' ',I � HORCit <br /> - <br /> OWNER MAILING ADDRESS: s-RrET ._. � ._ <br /> caQ� . <br /> CITY STATE .. rl- <br /> 011 <br /> OWNER PHONE f 4. �s, OWNER EMAIL: <br /> CONTRACTOR NAME: MERIDIAN CENTER ELECTRIC <br /> CONTRACTOR ADDRESS: s-ttrt r 1 1 109 66TH AVE <br /> (Ay PUYALLUP STATE WA zir,98373 <br /> CONTRACTOR PHONE:360-419-0580 CONTRACTOR EMAIL:MTVPRODUCTION@MCELECTRIC.COM <br /> CONTRACTOR LIC. R tREDLMERIDCE31 SSG CITY OF EVERETT BUSINESS LIC,#(R QUIRED);44 , £t E; � --{( <br /> PRIMARY CONTACT: DOWNER [✓CONTRACTOR D✓OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-419-0580 <br /> AMANDA BYERS CONTACT EMAIL:MTVPRODUCTION@MCELECTRIC.COM <br /> ' AGREEMENT 13w,eby codify that I have mod anti examined this application and know(he same to he true o.pd correct,_AO prOo4arekna cif laws and ar tr irn 5 governing that <br /> type of work will be completed whether spocilied herein or not; The granting of a permit does not presume to gtve authority to violate or cancel the provisions of any other slate or <br /> local taw reel dating construction or the performance of construction: Thal f am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with tho State Contractors Law 18,27 RCW end 296 200 WAC. City of Everett Official Use Only <br /> I PERMIT`ft' <br /> etfriai . � Ey: q4 (ILt <br /> „„, r ethorizee!Agen ignettirl Date (fttivistrd 9yftl 19) 1Page1-Applicahon <br /> 11z <br />