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ELECTRICALR TA puc rlOON <br /> , ,,elj_P,. -, <br /> CITY OF EVERETT PERMIT SERVICES <br /> d' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ......r , (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everetfwa.gov/permits T��_`� <br /> PROJECT SITE; RIVIATIOI►�.-, — ----7. . — <br /> _.. — — — <br /> PROJECT ADDRESS: j,_.L (c,��i,/1.C7 t !BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION D ADDITION ©TENANT IMPROVMENT © REMODEL 0,4 t,{�t' _ <br /> BUILDING USE: ® SFR 1-1 TOWNHOUSE El DUPLEX <br /> `S a ADU DI MULTI-FAMILY-#OAF UNITS: W COMMERCIAL ! <br /> CONTRACT PRICE OF WORK:$ :3, C Zi ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: L YI s 1( alit I ? d— Pk) (( L-C't 0 I .-(-blCf iv i-— L ( `:i -' <br /> c caT3 io 5 i :i') is_je-, Ado /%,/2 l c (Ol d <br /> qc. L/( b I 1 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) �' .-z <br /> LINE VOLTAGE WORK? LENO 0 YES-Select Scope: (J Service 0 Feeder El Circuits-#: / X Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO 1111 YES-#of Devices: e- <br /> SELECT SCOPE (REQUIRED): <br /> Ia Data • Intercom ®Thermostat a Audio 'MI Secure Access ® Security System <br /> 111 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 /> CI Other(List All): <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES--See Below&Pg.2 <br /> CI By checking this box, I am stating that I have read and understand all of UVAC 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: PINO DYES-See Below&Pg. 3 <br /> ri Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> LA 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 /> - �+QlstI` GT:tf��'fJR1Vlh'�"It'�R , : . <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET CITY -- <br /> STATE ZIP <br /> - <br /> OWNER PHONE: !OWNER EMAIL <br /> ,CONTRACTOR NAME: hip 1 Ye SG l ec-f ir i Zw( t-1C VI(-Le S <br /> CONTRACTOR ADDRESS: STREET Flo <br /> ,n /�/2051 t f <br /> CITY 6 c to t`1 L Ai 17 STATE (,,,t.�C� ZIP Cf 7 2_J� <br /> CONTRACTOR PHONE: 5-34/.-7327 CONTRACTOR EMAIL: . ,r�z D i_=,A- L. 6-ipinhc..e-I'ecd-nt-11 G63 iI I EJ <br /> CONTRACTOR LIC.#(REQUIRED) A /}� L Cf.�l 1�I-F ICITY OF EVERETT BUSINESS LIC.#(REQUIRED) 413yN/ <br /> PRIMARY CONTACT: 0 OWNERONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 5-3 ((. - 73 2 7 <br /> ) ` `it ,_2 CONTACT EMAIL: - f <br /> AGREEMENT:VL hereby T� <br /> AGREEMENT:I hereby certify 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 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 <br /> o for <br /> Ewhicht Opic lica ati ion <br /> s ma ymade is and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. 2D1PERMIT#: <br /> '— /9—i? . E 161 (3' -' t) 3 ___ <br /> 0 Au onzed Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />