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{ <br /> • <br /> ELECTRICAL PERMIT APPItATION <br /> EVERETT MY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> warsMrNotora (P)425-25a-a910 1 FAX42S35i-8651 i(E)averekepaeeveref[wa.gov i vwsareverettwa.gewps <br /> Pit• 1 fa ; ioN". <br /> PROJECT ADDRESS: 112 Se Everett Mall Way Everett,WA 98208 BUILDING AREA: 1000 sq ft <br /> PROJECT TYPE: CI NEW CONSTRUCTION D ADDITION m TENANT IMPROVMENT D REMODEL <br /> BUILDING USE: D SFR D TOWNHOUSE, ❑DUPLEX 0 ADU D MULTI-FAMILY-.#OF UNITS: 0 COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ 1825 ASSOCIATED BUILDING PERMIT*(if'applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Replace (5) exterior sconce lights with LED security Ii•hts <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPL <br /> LINE VOLTAGE WORK? m NO ❑YES-Select Scope:D Service 0 Feeder 0 Circuits-#: D Complete Re-wire <br /> LOW VOLTAGE WORK? ®NO D YES-#of Devices: <br /> SELECT SCOPE'{REQUIRED);D Data D Intercom ❑Thermostat ❑Audio D Secure Access D Security System <br /> 0 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 CAREFACILITIES: 1i NO ❑YES See Below&Pg.2 <br /> Sy checking this box,I am staling 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:QNO DYES-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: '.Lovers TENANT BUSINESS NAME(if Commercial):Lovers <br /> WNER MAILING ADDRESS:. STREET 112 SE Everett Mall Way <br /> CRY Everett $TALE WA aP 98208 <br /> OWNER PHONE 'OWNER EMAIL: <br /> CONTRACTOR NAME: Mastercraft Electric,Inc; <br /> CONTRACTOR ADDRESS: sm a r206 Frontage Rd. N. Ste. A2 <br /> myy Pacific_ STATE WA VP 98047 <br /> CONTRACTOR PHONE:253r737.4367 (CONTRACTOR EMAIL:chadw@mestercraftinc.com <br /> CONTRACTOR LAC.#(REQUIRED):MABTEE1127B8 kITY OF EVERETT BUSINESS LAC.#REQUIRED):055704. <br /> PRIMARY CONTACT: DOWNER QCONTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-295-0089 <br /> KIM DARLINGCONTACT EMAIL:kit d{ mastercrafth C.Com <br /> ordinances <br /> AGREEMENT I hereby certify'that i have mad and:exa=ris eppicallop and know the same to be titre andcaract A►avi�onS of laws and <br /> type of work I be oornpleted whether speci d herein ornat. The granting of a permit.does not presume to ghee aufhofilY to violate ofGar+cei made and <br /> the p+ovkl°s°r+m►+Y° state o <br /> beat law vegulafl ammt ur�ora or the peifomaaace'of consau on. That 1 am authorized by the owner al this.pr+operty Ira perform the te!wtddm I k <br /> con►piy w#h the to Contractors Law 7$ C.27RCW and 29&200 WA .: of EvorWt Ofltaial ila <br /> P MIT(l: <br /> MAWR <br /> 3!2/20 f :19 <br /> Si .. Date <br /> Scanned with CamScanner <br />