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°.LECTRICAL PERMIT APPLI.,,ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa,gov www•everettwa.gov/permits <br /> PROJECT ADDRESS <br /> $ I0 ' S; c, " <br /> PROJECT TYPE: Li NEW CONSTRUCTION ❑ADDITION I1 TENANT IMPROVMENT BUILDING <br /> LI REMODEL sq <br /> BUILDING USE: ❑SFR <br /> ❑TOWNHOUSE Ll DUPLEX ®ADU 0 MULTI-FAMILY-#OF UNITS: <br /> •. ,�� � � COMMERCIAL <br /> b. <br /> CONTRACT PRICE OF WORK::$ r. a <br /> f) 0 ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> art- IteuA. <br /> r <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPL <br /> LINE VOLTAGE WORK? ❑NO 0 YES-Select Scope:❑Service ❑Feeder ❑Circuits-#: <br /> LOW VOLTAGE WORK? LI NO ®YES-#of Devices: Com tete Re-wire <br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom <br /> Thermostat ®Audio 0 Secure Access ®Security System <br /> ❑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 /> .,""_. .., �, 01- PI.F " <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES O..- a e <br /> E By checking this box, I am stating that I have read and understand all of WAC 298-468-900,selected•eS specific—See Belowo & page on 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the followingsections <br /> that dot 2 <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: F_'!NO 'OYES-See Below&Pg.3 <br /> (- `" Pursuant to RCD/18"28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> L. .. without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that 1 have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this IlcensinglcertlflCation requirement. <br /> OWNER NAME: kt 7 1 1�� � •7 _ <br /> ,� TENANT BUSINESS NAME If Commercial : c""e L'y ' tie- le* <br /> OWNER MAILING ADDRESS: STREET C <br /> cry k <br /> OWNER PHONE: J;.. j c `t'° STATE Ls <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: 6 0 Sci-} 4GUCCT12.1 C., INC. <br /> CONTRACTOR ADDRESS: STREET <br /> P0 60Y 10(65 <br /> CITY L',,,I.14-C cj T-6 V°Iy N s STATE %.A)A <br /> CONTRACTOR PHONE: 416 ;, Zip q 32,5g <br /> 5 CONTRACTOR EMAIL: bes c k e��c f-i-a c Cot. lhAl 0 o k, C ol�vs <br /> CONTRACTOR LIC.#(REQUIRED: ;OCH 6-I[. q 3 Q r CITY OF EVERETT BUSINESS LIC.#(REQUIRED: Oct . <br /> PRIMARY CONTACT: ❑OWNER L�LCONTRACTOR <br /> OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 61-a g 74 5- <br /> 012 445 421, q uir 6 <br /> ToE 1305C14CONTACT EMAIL: <br /> AG- "'M t he;•y cert/ty rhe ! ave Tea•and exam nail, .a pc c�t e C c f d i e i to a �' ®t.af bit)L Ct.�`tvi <br /> AG' <br /> Of Work wino com ceted whether sPectfted app` :,,•n an.know a same ro..true and conga! 'rpm ,.ns <br /> local •law regulating wino con slued he the pecifled herein or not. The granting of a authority to violate or cancel the provisions of any other permit does not presume to give au -ws ah•ori nanpes governing this <br /> performance of construction. That/am authorizer/by the owner of this p state or <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> property to perform the work for which app/kation is made and t <br /> PERMIT C- of Everett Official Use Onl <br /> • wired Agent Signature E <br /> Date <br /> (Revised 111 /2Q19) Page 7-Appticaflon <br />