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i • • <br /> C LECTR C s LL CAL RM LT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> F• L sT" 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I wvrw.everettwa.gov/perms s _ _— J_� <br /> — PROJECT SE FGEZEfl u �n E ,E t tIO <br /> PROJECT ADDRESS: `�(v c� S,,,1 `'f1-T"1 7 4 1Q !BUILDING AREA: sq ft ` <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION TENANT IMPROVMENT 0 REMODEL J <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> I UCTEUCAL APPLICATFOE4 luv it u,,vrom &PEOGRCPT EI Or �' OR <br /> CONTRACT PRICE OF WORK:$ 1Pq (� ! IATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: A�.L.,, Av4`(1 qr4-I.A C T <br /> R <br /> THIS INSTALLATION INCLUDES THE FOLLOW! SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: / 0 Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED) 0 Data ,� Intercom 0 Thermostat E Audio .0 Secure Access 0 Security System <br /> : <br /> I D 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 /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ 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 /> I See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®NO OYES-See Below&Pg. 3 <br /> EziPursuant 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 /> I <br /> I See Page 3 signedthe AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT ! FOR�`lAT ON <br /> OWNER NAME: <br /> TENANT BUSINESS NAME If Commercial : <br /> OWNER MAILING ADDRESS: STREET 1 <br /> STATE ZIP <br /> CITY <br /> OWNER PHONE: OWNER EMAIL: ��..� .: <br /> (CONTRACTOR NAME: (CJLyOScrN 'OGO- «- t / c <br /> CONTRACTOR ADDRESS: STREET ,[✓"J(� E��`�,,K �(e( <br /> ��'-��- <br /> CONTRACTOR PHONE: <br /> CITY -"�Vc-, ( "Ai STATE Jk ZIP 1 <br /> CONTRACTOR EMAIL: 4 Scnge Q/kc-�VCL@ L`L`t- . Cc e.— <br /> CONTRACTOR LIC.#(REQUIRED): 'CITY OF EVERETT BUSINESS LIC.#(REQUIRED): -3 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: tp--'- 7,51-5-n$ <br /> 5 c- s <br /> CONTACT_ EMAIL: <br /> AGREEMENT.'I herebyy certify that 1 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 constructio r 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 /> City of Everett Official Use Only <br /> comply with the State Contra La 18.27 RCW and 296.200 WAC. ;PERMIT#: <br /> ---*--)--)01 S <br /> 4 <br /> Owne orized nt nature <br /> --- <br /> Date (Revised 1/11/2019) Page 1-Application <br />