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Low ELECTRICAL PERMI
<br /> T APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASH IP4�TON (P)476 257 6810 FAX 425.257-se57 I(E)cvoretteps@;evorettwa,
<br /> p2 gov I wwweverettwa.gov/permits
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<br /> 524 75th St CC �c+ A
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<br /> PROJECT ADDRESS: BUILDING AREA:
<br /> sq ft
<br /> PROJECT TYPE; ❑ NEW CONSTRUCTION J ADDITION ❑ TENANT IMPROVMENT ❑REMODEL
<br /> USE: ❑SFR E TOWNHOUSE OF U ❑ COMMERCIAL
<br /> BUILDING � DUPLEX ❑ADU ❑ MULTI-FAMILY #I; 5 d ., '! " ;E[40.CTRI.CAtAPPII��°T11WiliNISpRM p�BUILDING� &:1.P ERIM xMr TARNiPIE WQRNa"Ug ir3 Mt °
<br /> CONTRACT PRICE OF WORK:$ 12000.00
<br /> #(if applicable): '
<br /> DESCRIBE SCOPE OF WORK;
<br /> install electric lock on gate, repair existing locks
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? kNIO ❑ YES Select Scope: Li Service CI Feeder ❑Circuits-#;_ ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO [DYES-#of Devices:4
<br /> SELECT SCOPE(REQUIR ❑
<br /> EC): ❑ Data Intercom ❑Thermostat ❑Audio El Secure Access
<br /> ❑ Security System
<br /> El 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: NO ✓ E S--, ee�<B.
<br /> /i By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specific easlon on ow& page 2
<br /> — u 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. LINO ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: LINO EYES-See Below&Pg. 3
<br /> 7 1
<br /> Pursuant to RCW 19.28,261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease
<br /> l 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 /> AAAT k , �"�' Ihl I �.,yq �i .rh 14 ; � '"'
<br /> OWNER NAME: Terrace at Beverly Lake
<br /> OWNER MAILING ADDRESS: STREET 524 75th St SE
<br /> CITY Everett STAT:wa ZIP 98023
<br /> OWNER PHONE:425-348-8800 OWNER EMAIL: y d@theterraceatbeverl Iake.com
<br /> CONTRACTOR NAME: Guardian Security Syst,...,, .,.ems
<br /> CONTRACTOR ADDRESS: STREeT 1743 1st Ave so
<br /> CITY Seal,the STATE Wa Z,, 98134
<br /> CONTRACTOR 0' ' CONTRACTOR EMAIL:mgere@guardiansecurity.corn
<br /> ( w.,,
<br /> EVERETT BUSINESS LIC,#RE4UIRED :a33443
<br /> PRIMARY CONTACT: Ill OWNER =(I;-�I CONTRACTOR ❑OTHER(Please specify)
<br /> CONTACT NAME: CONTACT PHONE:206--467-5262
<br /> Mary Gere CONTACT EMAIL:mgere@guardiansecurity.com
<br /> AGREMNT.'I hereby certify that 1 have road and examined this application and know the same to be true antl correct All provls/offs Of laws and ord/nancr_5 govemrng this
<br /> type of work will be completed whether speclriod herein or not. Thy granting or 1 permit does not presume to give authority to violate or cancel the rovisions of anyother
<br /> local law regulating co rct/on or the performance of construction. That I am authorised by the owner of tills property p and
<br /> I or
<br /> comply with the St tractors Law 18.27 RCW and 296.200 WAG. P party to perform the work For which applicationiaU Is made and I
<br /> City of Everett official use Only
<br /> PERMIT via
<br /> 5-bkb0 /q LE V \CAS- V6,2_,
<br /> , ,
<br /> gwner/Authorized Agent Signature Date
<br /> (Revised 7/11/20793 Page 7-Application
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