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Sillily <br />ELECTRICAL PERMIT APPLICATION <br />EVERETT <br />S2CITY OF EVERETT PERMIT SERVICES <br />M CEDAR STREET. EVERETT, WA from <br />IP1425252-Vale I FAx 425-252.0952 1SE) eve/enepe@eve,epwa gevl MW/.everoRNa.Rwlpelmne <br />F.r:• <br />PROJECTAODRESS: 1509Broadway BUILDINGAREA: 130 t R <br />PROJECTTYPE: %NFWCONSTRUCTION 1ADDITWN -1 TENANT IMPROVMENT —IREMODEL <br />BUILDING USE: XSFR -1 TOWNHOUSE (DUPLEX 'ADU MULTIFAMILY-e OF UNITS COMMERCIAL <br />t ^:vx:rrn. <br />CONTRACT PRICE OF WORKS 1000.00 JASSOCIAl LO HULLOING PERMIT 0(if applicable) <br />DESCRIBE SCOPE OF WORK: <br />built awe room storage with fi h6na <br />and electric outlets for stoma El OX13 and 8112 feet tall at back 61.r. <br />MIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ' NO <br />r YES - Select Scope -1 <br />Service '.^ Feeder F ClrwilsM: —) ConpNN Re -wire <br />LOW VOLTAGE WORK? 7NO (KYES.gol Dsvlces: 2wtleksendlidTE <br />SELECT SCOPE enrichment , 7 Deta -1 Intercom 1 Thermostat --I Audio —ISecure Aecoss Security Syalerll <br />I Fire Norm- Installations under (his potmN onlyinclude electrical wiring mugM1in of the system. An eddilonal <br />Eke Alarm Permit Is required for review of device location and Installation approval. <br />X Other (List All) OuVldelaht <br />a <br />ISTlilSPERLgt EDUCATION,INSTITUTIONAL,HEALTHANDIORPERSONAL CARE FALILIilES: %NO YES -See Belmv8Pg.2 <br />By thinking this has I am slating that I have read and understand all of WAC 296468 S00, selected (be specific reason on pegs 2 <br />of this application pee next page), AND Plan Revisal is NOT required because i meet all of the follmving sub sections that do rat <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:. "NO %YES -Sae Below8Pg.3 <br />Pumuant to RCW 19,28.261. property owns and Ieeseholdem cannot pedoml elechicalwo:k on buildings far rent, sale, or lease <br />vnthtut (he Vapor electrical licensing and codification, or exemption. By checking this box, I am sNting that I have completed and <br />see rages signed the AFFIDAVIT on Page 3 of this application to receive oil exemption from this Ncensingicertification requirement. <br />7,777s.. <br />OWNER NAME: An drew &Ta Ot at Su I TENANT BUSINESS NAME (if Commercial: <br />OWNER MAILING ADDRESS: singer 150SBroadway <br />oar Everett VAX Wa al, 98201 <br />OWNER PHONE: 1-425-532-9496 - <br />OWNER EMNL: d'ewsticiD shoo.or n <br />CONTRACTORNAME <br />CONTRACTOR ADDRESS: STPEET <br />RRY STATE LY <br />CONTRACTORPHONE ''CONTRACTOR <br />EMAIL: <br />CONTRACTORLIC. REDmRECK: ''CITY OF EVERETT BUSINESS M, atREDYIREDp <br />PRIMARVCONTACT: %OWNER CONTRACTOR OTHER (Please Specify) <br />CONTACT NAME CONTACT PHONE: 1-425-532-94% <br />Andrew BtTamare Sulc CONTACT EMNL: dewadcM ehoo.cam - <br />Andrew&Tamara Sure E 22-62. `'2­ 1i <br />DwnedAwbonae4 Agent Siemens DOW IRewme vrr.IM Page LAPPIIG <br />