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0 ! <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa,gov 1 www,everettwa.gov/permits <br />777, <br />am <br />PROJECT ADDRESS: t--,-50 " ' BUILDING AREA: sq ft <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION D6 TENANT IMPROVMENT ❑ REMODEL <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />+ri ._ _. :.HFM_ " _ r.. <br />WOR <br />CONTRACT PRICE OF WORK: $ 2-�D— ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: PI-P"'nI n re e-i e-i - r v- A n - . <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire t <br />LOW VOLTAGE WORK? NO ❑ YES- # of Devices: <br />SELECT SCOPE (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): ......... <br />S THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: /2!1,NO I 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 LICENSUR O OYES -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 receive an exemption from this licensing/certification requirement. <br />OWNER NAME:,�e_rry TENANT BUSINESS NAME If Commercial): <br />OWNER MAILING ADDRES : STREET I 3f� i F)f t + <br />STATE VV ► 7- L'Pi L I <br />WNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: C.M. HEATING INC <br />ONTRACTOR ADDRESS: STREET 1` /4115`h, <br />BROADWAY /� <br />cITV EVERETT STATE �r A zip 98201 <br />CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL. <br />CONTRACTOR LIC. #(REQUIRED): CMHEAMH877DN CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 016098 <br />PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR ❑OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 425-259-0550 <br />t <br />CONTACT EMAt lot,t <br />Viai <br />)AGREEMENT, t hereby certify that !trove read and a camwed this apphcatiori and knoty the same to be true and correct. All provisions of laft and o dinances governing this s <br />pe 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 />cal 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 />omply with the State Contractors Law 18.27 RCW and 296,200 WAC. City of Everett Official Use OnlyR , <br />PERMIT #: <br />Own Authorized Agent $ ure Date (Revised 1/1112019) Page 1-Application <br />j` <br />