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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3op3 W.0ASINO IZD• BUILDING AREA: 9J am+ sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: COMMERCIA <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ A&o ASSOCIATED BUILDING PERMIT#(if applicable): ►.S/A <br /> DESCRIBE SCOPE OF WORK: I t 4STA L- A"'> PP4e:P PPWl L3EW <br /> 6PA 9. PAA T BoOTAS <br /> 2-02-544o <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY <br /> LINE VOLTAGE WORK? ❑ NO YES-Select Scope:❑Service eeder Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑NO YES-#of Devices: 2 <br /> 1-1 <br /> SELECT SCOPE(REQUIRED): IJ Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System <br /> ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An <br /> additional 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: JoNo LJ YES--See Below&Pg.2 <br /> ❑ 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 <br /> 2 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:LJNO ❑YES-See Below&Pg. <br /> ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <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: THF- 1 of5-ii,46T C_="?AtW4 TENANT BUSINESS NAME(If Commercial): EOV_�tt4G <br /> OWNER MAILING ADDRESS: STREET Po 50x_ Z-10-1 <br /> CITY S.EATTLE STATE W ZIP I Z <br /> OWNER PHONE: Zo(o. 455.2121 OWNER EMAIL: WA <br /> CONTRACTOR NAME: SE UOYAR El ECTIP-1C L -.- <br /> CONTRACTORADDRESS: STREET 15135 RE 92rJD ST Q� <br /> CITY REA M ol\tD STATE WA ZIP '180,52. <br /> CONTRACTOR PHONE: 425.814• 600vo I CONTRACTOR EMAIL: an clq.Inoc�lr►9 @ Se uo �►•CoIrN <br /> CONTRACTOR LIC.#(REQUIRED): 5EQU0EA-`1"><1991 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 4o(P45 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR E]OTHER(Please Specify) <br /> CONTACT NAME: ,, ({jpr-'1EN, CONTACT PHONE: 240(c.e>kq. $.42 <br /> rVROJVECT MjkKKjER. CONTACT EMAIL: 046n 6—D 56 L4 A •com <br /> AGREEMENT/hereby certify that 1 have read and examined this application and know the same to 65 true and correct. AllprovWons cf.Mws 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 <br /> or local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 9..9. 200Z E <br /> Owner uthorized A6enf Signature Date (Revised 41512022) Page 1-Application <br />