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4111 <br /> ELECTRICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WAS HINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2410 38th St BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COM ERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION ORK <br /> CONTRACT PRICE OF WORK:$ 250.00 ASSOCIATED BUILDING PERMIT#(if applic e): M1940-119 <br /> DESCRIBE SCOPE OF WORK: <br /> Add 120voit circuit for gas unit heater <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope:❑Service ❑Feeder ❑✓ Circuits-#:1 ❑Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑Data El Intercom ❑Thermostat El Audio El 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): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ElNO ❑YES--See Below&Pg.2 <br /> rBy 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 /> 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 /> nI I 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 receive an exemption from this licensing/certification requirement. <br /> CONTACT. INFORMATION <br /> OWNER NAME: Canam Investments TENANT BUSINESS NAME(If Commercial):Cascade Floral <br /> OWNER MAILING ADDRESS: STREET <br /> CITY <br /> STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Dahl Electric <br /> CONTRACTOR ADDRESS: STREET3409 McDougall Ave <br /> CITY Everett. STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:4255-2552-1700 CONTRACTOR EMAIL:dSteVenS@dah(eiectrlc.com <br /> CONTRACTOR LIC.#(REQUIRED):DAHLEE1926QD CITY OF EVERETT BUSINESS LIC.#(REQUIRED):037-024 <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT'PHONE:42rJ-293=0978 <br /> Adam Van Winkle. CONTACT EMAIL: <br /> AGREEMENT:l hereby certify that l have read and examined this application'and know the same,to be true and correct. All provisions of laws and ordinances governing this 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 l am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of,Everett Official Use Only <br /> PERMIT#: <br /> 011,, /I— al-al-1 E Y:3\ 3 LA <br /> Owner/Authorized Agent Signature Date <br /> (Revised 1/11/2019) Page 1-Application <br />