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ELECTRICAL.PERMIT APPLICATION <br /> E CITY OF EVERMPPERMIT SERVICES <br /> 3200}CEDAR STREET.EVERETT,WA 98201.: <br /> wnsHMOIGN (P)424•257.881p I FAX 42S2b7.8Q5T 1'7 7 (E)evereilops:icoYerethva.pevi WyAY•avareltwa.govlPBrnt118 <br /> . '. .' PRb..)Rittw fiE ttV.. 1 "Fll?1l� ,. .. <br /> PROJECTAODRESS: 1000 SE Everett Mail WRY310 ISUILDING AREA:$833 sq ft <br /> .. <br /> PROJECTTYPE: ❑NEW CONSTRUCTION. ❑ADDITION t'Q TENANT itvIPROVMENT ❑REMODEL <br /> BUILDING USE: O SFR CI TOWNHOUSE Q DUOI* ;D ADU :O MULTI-FAMILY-#OFUNITS: COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ 36987.00 JASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK, <br /> Demo make safe as needed and removal of existIng fixtures <br /> Installing new miso LED lighting and power fol'tenant im rovm©nt <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:j8ELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ✓( I NO ❑VES-Select SCo o: Service ❑Foedat ❑Circuits-M 0 Complete.Ro4fie <br /> LOW VOLTAGE WORK? ONO Q.YES-#of Deviceei <br /> SELECT SCOPE(REQUIRED); Data ❑Inter* <br /> Porn Q Thermostat ❑Audio ❑Secure Access. ❑Seourlty System <br /> ❑Fire Alarm.-Installations under this permit only Include electrical wiring rough-in of the system:Apt additlptlal <br /> Fire Alarm Permit fs_required for review of device location and installation approval. <br /> [Q Other(List All): <br /> IS THIS PERMIT EDUCAf ION,INSTITUTIONAL,HEALTH AND#OR PERSONAL CARE FACILITIES; ✓ NO Lj YES--Sea 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 t meet all of the following sub sections that do not . <br /> Seo page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSUREi ✓NO OYES-See SolowA.Pg.3 <br /> Pursuant to RCW 19.28.281,property owners and leaseholders cannot perform electrical work on buildings for rant,ealo,or lease <br /> without the proper electrical,licensing and certlgcallon,or exemption.By checking this box,I am stating that I have completed and <br /> sae Page 3 signed the AFFIDAVIT on page 3 of this applioatlon to receive an exotnption from this Iicensinylccctification requirement. <br /> OWNER NAME:Colliers International <br /> TENANT BUSINESS NAME If Commsrclal <br /> OWNER MAILING ADDRESS: STnEr,0500 Harbour.Heights Parkway,Sulte•107 <br /> care Mukiltso STATE WA zri$.8275. <br /> OWNER PHONE,425-315-1354 OWNER EM1HL:john.bausch@colliers,com <br /> CONTRACTOR NAME, Olsen Electric Inc <br /> caNrRAcros aaaREss: a,.e,325 Washington Ave S#91 <br /> Jnr Kent STATE WA zP 94o:3,z: :. <br /> CONTRACTOR PHONE:253-872='1905 CONTRACTatt EMaL:Angelg@olsenelecllic.net <br /> CONTRACTOR LIC.#(REQUIRED.0LSENE1931PE: °. CITY OF.EVERETT BUSINESS LIC.#(REQUIRED:046102.' <br /> PRIMARY CONTACT: DOWNER O✓CONTfiACTOR '.j]OTHER(Please Specify) <br /> CONTACT NAME: t CONTACT PHONE:253-872.1905 <br /> 'Jordan Berens+: CONTACTEMA4.;Angelg@olsenelealric,net <br /> GREEMENTJ horn y CetAl that I lave read and eXarnOod this application and know If;same to be true and corrdc.AM provisions allows'and ordinances governing this <br /> typo of work will bo cvmpfefod whother speadfed heietn or rioL Tho proofing of a pe,nnif Joos not presume,to givo outhwily to violate or cahoot the provisions of ony:other state or <br /> local law rogulating aonstnxflon or the pwormawo ofcanstruelion. Thet.f par awhof zed by the owner of this properly to porform the work for which application is rnade and I <br /> comply w th rhe Sta16 Controctnrs Law f8.21 RCW and 298.200WAC. City of Everett Otnclat Use Only <br /> PER <br /> tom' 1 E 2- <br /> JAM <br /> Ow arlAut Axed Agent 191pnalur Date " . evised 1/119019) Pa 1-App ieatlon <br />