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• • <br /> ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32 CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 273( WErMo2E' tithic - FL-4 (BUILDING AREA: W5"-- sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION cgr TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: '1 COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 3S�000. 00 ASSOCIATED BUILDING PERMIT#(if applicable):l `aj.O I 03f 1 <br /> /. <br /> DESCRIBE SCOPE OF WORK: 64 Ui4 AXM//t�c, �INtI ic` /O� f eezr A' <br /> lit h,f4 ,ieft./iAdtr.t AA-so CoN tiwxkee atcuPrr• <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO "YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: /Z ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? I 'NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access ❑ 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): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: y? NO ❑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 LICENSURE: NO ❑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/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: FuNkb TENANT BUSINESS NAME <br /> (I(If <br /> ^Commercial): FUN)KO <br /> OWNER MAILING ADDRESS: STREET 24) 0Z Ii/'E O// 41 �//� <br /> CITY Q Err STATE ZIP 9i� <br /> OWNER PHONE:ZOb• 78$. OWNER EMAIL: licia. •� <br /> I • <br /> CONTRACTOR NAME: P(tEFE(( E15 eleaIlO C <br /> CONTRACTOR ADDRESS: STREET 130X�'/�?/�1 20 <br /> CITY S /J[/�� STATE ZIP <br /> CONTRACTOR PHONE:'jA , [CCOONTRACTOR EMAIL: E�c e(`,-'.tr����►If eledY!G• UJ <br /> ��' q CITY OF EVERETT BUSINESS LIC #(REQUIRED) 047/�s1p <br /> CONTRACTOR LIC #(REQUIRED) REFI9KS�li IP. <br /> PRIMARY CONTACT:�����, �...t�,�.�e ,.. .0 ..,,v. �._ �� �._ ...�. .:�,�t. .� , <br /> DOWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 12,43:, . 1419 , Le' <br /> Lpr 0� CONTACT EMAIL: tecca,ote.���rY��� G.VS <br /> AGREEMENT I hereby certify that I have read and examined this application and know the sa 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 violate 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 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 /> E 2Ob2.-ZZq <br /> Owned thoriaed A nt ignature Date/ (Revised1/11/2019) Page 1-Application <br />