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amis <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)42S-257-8810 FAx 425-Z57-8851 (E)everetteos@everettwa.gov www,everettwa,govipemlits <br /> • - • • • • • PROJECT:SITE INFORMATION <br /> PROJECT ADDRESS: 120 West Casino Road BUILDING AREA: sq ft <br /> PROJECT TYPE: El NEW CONS TION 0 ADDITION El TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: El SFR ' TOWN OUSE 0 DUPLEX El ADU MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> ELEC IkAL PLICATION:INEORIVI*1100,140SECRIPillaOl*OPRIKict:644:111 <br /> CONTRACT PRICE OF WORK:ci 1,100 ASSOCIATED BUILDING PERMIT#(if applicablet' <br /> DESCRIBE SCOPE OF WOR <br /> Replace damaged feeder t't-g to Apartment#28F <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? [2] NO E YES-Select Scope:0 Service El Feeder El Circuits-#: E Complete Re-wire <br /> LOW VOLTAGE WORK? Ej NO CI YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data 0 Intercom El Thermostat El Audio 0 Secure Access 0 Security System <br /> LI 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 /> Replace damaged feeder <br /> (Zi Other(List All). <br /> , CODkcOMPLIAISIcik&N#t*,,,,, , :.<;•••:•:, • <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: n NO rn YES See Below&Pg.2 <br /> By checking this box.I am stating that I have read end understand all of WAC 296.468-900,selected the specific reason on page 2 <br /> 7 . 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:ONO EYES-See Below&Pg.3 <br /> — Pursuant to RDW 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 codification,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 /> • W: CONTACi INFORMATION <br /> OWNER NAME: Park 120 Apartments TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smE.E7 120 West Casino Road <br /> Everett STATE WA 7,,98204 <br /> OWNER PHONE: 206 376-9927 ,OWNER EMAIL: <br /> CONTRACTOR NAME: Boyer Electric Company Incorporated <br /> CONTRACTOR ADDRESS: STREET 8119 240th St SW <br /> em, EdmondsWA <br /> STA'M 2,p 98026 <br /> CONTRACTOR PHONE: 206 367-7606 CONTRACTOR EMAIL: karen@boyerelectric.com <br /> CONTRACTOR LIC.itfREOUIRED): BOYEREC101LE CITY OF EVERETT BUSINESS UC.#(REQUIRED): 22147 <br /> PRIMARY CONTACT: DOWNER 1;11CONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 367-7606 <br /> Karen Hanson CONTACT EMAIL: kafen@DOyereiBetriC,COM <br /> AGREEMENT'i hereby certify that have read and examined tfr seek:saran and knew the same to he true end correct. Akproviskros of laws and ordinances governing:ha <br /> type of work wet Se completed whether specified herein or not, The granting cif a permit does not presume to give authordy to violate or cancel the provisions of any other state or <br /> local law mutating construction or the performance rat constrectiom That!am authorized by the owner of Mrs property to perform the work for which application is made and? <br /> comply with the State Contractors Law 18 27 RCW and 296200 WAC. City of Everett Official Use Only <br /> PERMIT 4: <br /> Cytc-1, 1t2: f, E 9CDiq <br /> yderiAuthorlzed Agee gna re Date (Revised 1111/2019) Regal-Application <br />