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ELECTRICAL RMIT & FIRE ALARM PORMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 5415 Evergreen Way, Everett, WA 98203
<br /> PROJECT TYPE: ANEW CONSTRUCTION I1ADDITION F271 TENANT IMPROVMENT nREMODEL
<br /> BUILDING USE: [SFR 0 TOWNHOUSE 0 DUPLEX 0 4DU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> BUILDING AREA: 2...,.0<C9P.' sq ft
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<br /> CONTRACT PRICE OF WORK:$ 1,500 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? ❑ NO 0 YES-#OF DEVICES: 8
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<br /> IS THIS A FIRE ALARM PERMIT? ❑ NO ,❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: Add 3 new strobes and relocating 5 smoke detectors
<br /> THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> 7 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 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 /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:
<br /> 0 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 and 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 licensing/certification requirement.
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<br /> OWNER NAME: Coastal Community Bank TENANT BUSINESS NAME(If Commercial): Coastal Community Bank
<br /> OWNER MAILING ADDRESS: STREET 5415 Evergreen Way
<br /> CITY Everett STATE WA ZIP 98203
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Seacom Cabling
<br /> CONTRACTOR ADDRESS: STREET 3014 Hoyt Ave
<br /> cITY EverettSTATE Wa ZIP 98201
<br /> CONTRACTOR PHONE: 425-317-8259 CONTRACTOR EMAIL: KOLSEN@CALLSEACOM.COM
<br /> CONTRACTOR LIC.#(REQUIRED): SEACOC1944D0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053655
<br /> PRIMARY CONTACTWNER CONTRACTOR OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-317-8259
<br /> Ken Olsen CONTACT EMAIL: KOLSEN@CALLSEACOM.COM
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws 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 and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERKIT#
<br /> Ken Olsen 11/28/2018
<br /> nk IS I'051.
<br /> Owner/Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3
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