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'■M" ELECTRICAL PERMITAPPLICATION ` ��° <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 5200 CEDAR STREET,EVERE1T WA 9.0201 <br /> 011) <br /> WASHINGTON (P);425 2574810 ( FAX 425457-8857 )(E)everettepa•everettwa.guv 1 w ww everettwa govtpermits <br /> PROJECT ADDRESS: 701 76th St SE APT#332 BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU Il MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ 900.00 ASSOCIATED.BUILDING.PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK' <br /> Replace old panel with new 126A ML panel <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO El YES-Select Scope:Et Service 0 Feeder 0 Circuits: 0 Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED).0 Data 0 Intercom 0 Thetrndstet 0 Audio 0 Secure Access 0 Security System <br /> 0 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 /> 0 Other(List All): <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: r2 NO ■ YES--;See Below&Pg. <br /> flBy checking this box,.I am stating that I have read and understand all of WAC 296-4813-900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet ail 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: ®NO I YES-See Below&Pg.3 <br /> Pursuant to ROW 19,28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing artd certification,or exemption.,Sychecking this box,I am:stating that I have compteted and. <br /> See page 3 signed the AFFIDAVIT on page 3 of this application to receive art exemption from this licensing/certification requirement. <br /> 'DINNER NAME:WilliaMS investment TENANT•BUSINESS NAME(If Commercial):. <br /> OWNER MAILING ADDRESS: STREET 19801 50th Ave West <br /> crry Lynnwood: STATE WA zip 98036: <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Rhema.Electric <br /> CONTRACTOR ADDRESS: STREET 628 South Spruce Street <br /> cffy Burlington sT,hTE WA zrr 98233 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:DaVeb * r IOITta 3ieC'(ric.GC►l"ti <br /> CONTRACTOR LIC. (REQUIRED):RHEMA9400H CITY OFEVERETT BUSINESS LIG.##(REQUIRED):45783 <br /> PRIMARY CONTACT: DOWNER 2ICONTRACTR ❑OTHER(Please Specify) <br /> CONTACT NAME:pP�� C� CONTACT PHONE:360-630-0164 <br /> Dave L7 CONTACT EMAIL:diiveb t@r hemaelectriC.cofn <br /> AGREEMENT:thereby.can*Merl have teed en,examined this app'cat• 'sod ow 1".same'is be hate,girt.comet Ail provisions oflaws,and ordinances governing this <br /> type of work will be completed whether specified herein or not Themanting of a permit does ndt presuroe to give authority to violate or cancel the provisions of any other stale or <br /> local law.regulating construction or the perlormanCe or construction. That t arn•authorized by the owner of this property to perform the work for which application is made anti <br /> ,ty.with.the:State tractors Law#tt2'7RGWarta 298200WAC. City of Everett consist Use Ostiy <br /> PERMIT#: <br /> .5://f/K? E nos ,0 <br /> QwnerfAuthorize t Signature Da (revised 1/11ath9); Pagel-Application <br />