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0 • <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> ,11111 <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 3200 CEDAR STREET, EVERE I I,WA 98201 <br /> (P)425-257- 810i I FAX 425-257-8857 (E)everetteps@everettwagov 3 wtww.everettwagavipermits <br /> tE+C"t INFO. • TI <br /> PROJECT ADDRESS: 131 3 .„0 a f cE,` t q to \ <br /> s PROJECT TYPE; ®NEW CONSTRUCTION LI ADDITION LI TENANT IMPROVMENT 14f REMODEL <br /> BUILDING USE: D SFR E.TOWNHOUSE LI DUPLEX ❑ADU ®MULTI-FAMILY-#OF UNITS:01*H El COMMERCIAL - <br /> BUILDING AREA: 800 y scl ft otAtyf° .e r3i"". Q it- <br /> CONTRACT PRICE OF WO Jlf't..tIP:1��"�t�al INFORMATION <br /> $3250 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE ORK? Q El YES-*OF DEVICES: <br /> IS THIS A FIRE ALARM P NO El YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK: panel change in unit 7-ground outlets,replace romex in kitchen with commerical wire.add <br /> can lights, <br /> IS THIS PERMIT EDUCATION,I iNSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO El YES--See Below&Pg.2 <br /> rBy.checking this box,1 am stating that I have read and understand all of WAC 296-46B-9OO,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 Pare 2 require Plan Reviews <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:FANO EYES-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 lease without <br /> the proper electrical licensing end certification,or exemption,By checking this box.I am stating that I have completed and signed the <br /> See page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensingicertification requirement <br /> co/ 4T li !O <br /> OWNER NAME: Todd Sinms TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sr;r,F-not sure <br /> STATE Z, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAMEAMerIcan Electric Washington INC <br /> CONTRACTOR ADDRESS; r-:Et*8O53 16th ave NW <br /> im Seattle SATE WA , 98117 <br /> CONTRACTOR PHONE:4 `947-0909 LCONTRACTOR EMAIL:keith@aew-tnC.COm <br /> CONTRACTOR MC.#(REQUIR ):ameriew911 mh CITY OF EVERETT BUSINESS LIC.#(REQui LED): 017838? <br /> PRIMARY CONTACT: E,OWNER F1 CONTRACTOR :II OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:2539883 i 5 <br /> Keith Johnson CONTACT EMAIL:keitht a -in0.corn .. ,.. <br /> AGREEMENT:I hemby certify that I have read and examined this application and know the same to be true and correct Ali provisions ofIaw✓s and ordinances <br /> governing this 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 <br /> provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made end i comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Offi ie{Use Only <br /> PERMIT <br /> i: JtL - <br /> 1-10-19 l <br /> (D10 <br /> OwnertAuthorizett Afjent Signature Date (Revised 7 115120187 Page 1-Application <br />