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'I III 452 0 <br /> Li ELECTRICAL PERMIT APPLICATION J <br /> VEry��� CITY OF EVERETT PERMIT SERVICESE <br /> K 3200 CEDAR STREET,EVERETT,WA 98201 <br /> arA>Eaztt4tos (P)425-257-8810 j FAX 425-257-8857 1(E)everetteps©everettwa.gov I wruw.everettwa.gov/permits <br /> PROJECT ADDRESS: 1103k t AVQ, fVerei.k--, WA Q($2D$ BUILDING AREA: sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: ❑SFR 0 TOWNHOUSE ❑DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS: [COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ (10.3 ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIBE SCOPE OF WORK: P1Scbf>t'hec r ono lrec.°i)1�ec,--1- i,k (t0) dev'c.eS <br /> Insi(,-,2 e to,\V)kAdcs v-IOsV• <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO ElYES-Select Scope:0 Service ❑Feeder 17 Circuits-#: lO i❑Complete Re-wire <br /> LOW VOLTAGE WORK? 12 NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): 0 Data El Intercom ❑Thermostat ❑Audio El Secure Access ❑Security System <br /> 0 Fire Alarm-Installations under this permit only include electric wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> El Other(List All). <br /> { .c._3. ..ti� }..iii d,,',1;alsi xG' r :..LSYvs i.'� K[.1 + 4� � sa ';.'SY . <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: r? 0 ■ YES—See Below&Pg.2 <br /> 1571 By checking this box,I am stating that I have read and understand all of WAC 29646B-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 0 <br /> AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: O ■YES-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/certf lcallon requirement <br /> OWNER NAME: TENANT BUSINESS NAME If Commercial : SS30l140V1C,-.,S <br /> OWNER MAILING ADDRESS: sir cei VO/J{/1' ltT��(�1--t fa, St 1/�f /� fl <br /> CITY /t l 1 t STATE V'A- ZIP 1 l.v <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:SQOt-Vac_ rz_C--t-k-- t t y' Cam• <br /> CONTRACTOR ADDRESS:`I 0 )s-FREE-I S '22-C X\" �S C-• <br /> `�}-` Cry 1�•(' STATE Cl?-0 .�" zip <br /> CONTRACTOR PHONE: 2 2 <br /> 53-'is'� -- k)3 CONTRACTOR EMAIL:`%el1'�C-flCt CI.tN( tri')e'r Sec'itL C,e.\ec /l(__(^/l <br /> CONTRACTOR LIC.#REQUIRED: 6lk IAet01-1ti ta`�(a�ava Iasi Iabji.II-'I-�3S[at • - s , Gzj-1 <br /> PRIMARY CONTACT: DOWNER CONTRACTOR <br /> '� ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: lap _IA 0 - f&C 1 Gj �,r <br /> DUSt1t1 U � <br /> �S \\ CONTACT EMAIL: C,�I,tS�t1� . trtAgs-eft &$-ecita(.Q,�'dy,L - ( Lot\ <br /> AGREEMENT'I hereby certify that I have read and examined this application and Avow 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 oblate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which epplcalhm Is made and l <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAG. City of Everett Official Use Only <br /> PERMIT#: <br /> �. - r - - E 0 -- O` 5 <br /> Ov�FrerlAuthorized gent Signature Date (Revised 1/11/2019) <br /> Page 1-Applicadon <br />