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. Adil <br /> # • <br /> NMI <br /> ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32 CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WA51 INGT0N (P)425 257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> OJECT.SITE`INFORMATION . 7 <br /> PROJECT AD ESS: 3833 Colby Ave �� 5 BUILDING A EA: sq ft <br /> PROJECT TYP . NEW ADDITION ❑TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR ❑T! - T.-_- l� DUPLEX CI ADU CI MULTI-FAMILY-#OF UNITS: CI COMMERCIAL <br /> I . <br /> ELEC 0- AL AP• , ,' „ ON INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF , •RK:$ N/A- at Fee ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE •F WOR <br /> Install new stree i•ht s-_• cabinet for Colby Ave - 39th St Traffic Signal <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope:© Service ❑✓ Feeder ❑Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑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: CI NO ❑YES--See Below&Pg.2 <br /> i 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: Z NO DYES-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[ease <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: City of Everett TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Sail Electric inc. <br /> CONTRACTOR ADDRESS: STREET 911 Slater Rd <br /> CITY Bellingham STATE WA ZIP 98226 <br /> CONTRACTOR PHONE:360-383-0911 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):SAILEI*066QZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):45676 <br /> PRIMARY CONTACT: ['OWNER ['CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425 257-8926 <br /> Euneka Richards CONTACT EMAIL:erichards@everettwa.gov <br /> AGREEMENT:I hereby certify that I have read and examined this application and know 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 violate or cancel the provisions of any other stale or <br /> local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERM'T#' ^I <br /> : qj 7 • tl1 . cf.g ,20v. E 2T. �,- 0 7 f 4 <br /> Owner/Authorized Agent St nature Date (Revised 1/11/2019) Page 1-Application <br /> 1 <br />