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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT ADDRESS:1 01 T ap e treet PROJECT TYPE: ❑ NEW CONSTRUCTION ❑✓ ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: ✓❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: sq ft arrnitT CONTRACT PRICE OF WORK:$11,000 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? El NO El YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? EI NO El YES-Plans required for review(Both Electrical and Fire Department inspections are required) yyu� yy� , ;1)*MileiTi'TwT:IVNIAISWn: WiZjigiNW':OW DESCRIPTION OF WORK: Knob tube rewire(9 circuits)and 200a Panel Change IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ❑YES--See Below&Pg.2 ❑ 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 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO DYES-See Below&Pg.3 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. ` Ct •NYAG FSR OWNER NAME: Kathy Verhey TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1101 Maple Street Everett WA 98201 CITY STATE ZIP OWNER PHONE: 425923-6710 OWNER EMAIL:everheykathy@aol.com CONTRACTOR NAME:twitch Electric CONTRACTOR ADDRESS: STREET7226 139th Ave NE CITY Lake Stevens STATE WA ZIP 98258 425-244-5511 service @ myswitchelectric.com CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):SWI I UEL91 HK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 052557 PRIMARY CONTACT: ❑OWNER I]CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-232-7467 Joe Schlegel CONTACT EMAIL:tiffany@ myswitchelectric.com 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 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 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 work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# V'1 1• 12/13/18 �. i g( z r i 03 Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application