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Feb 01 19 08:44a Bob Jack 1 Mj(f746777 p.1 <br /> ELECT.I 1• <br /> C L PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)4251-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I vww.evetettwagov/permits <br /> r. 'E zr <br /> �� iii <br /> PROJECT ADDRESS: < ) c J. BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0,,..!DDITION 0 TENANT IIVIPROVMENT 0 REMODEL • <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX ®ADU 0 MULTI-FAMILY-#OF UNITS: "4E OMMERCIAL <br /> ;r:: ,- ' E>LECTR1c. L APPU cA: 1®r INFO> MATIONAaw scRIPTIIQN OF W RK:i i :-::ft_ <br /> CONTRACT PRICE OF WORK:$ I' ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: - . < M <br /> MIIIIIIIIIIIIIIIIIIITHIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 61 NO 0 YES-Select Scope:0 Service 0 Feeder 0 Circuits-#: ®Complete Re-wire <br /> LOW VOLTAGE WORK? U NO YES-#t of Devices: <br /> SELECT SCOPE(REQUIRED): 'Data 0 Intercom 0 Thermostat 0 Audio *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 far review of device location and installation approval. <br /> 0 Other(List All): <br /> 1 _ rn <br /> •..t:. - „� .�: PCI- F�•E : ����� <br /> IS THIS'PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ►-' NO • YES--See Below&Pg.2 <br /> ® By checking this box,I am stating that I have read and understand all of WAC 296-46B-901,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 /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: Y.NO OYES-See Below&Pg.3 <br /> ® Pursuant to RCW 1928.261,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 /> • r ,.. . .. v, - . Y-.-.-ti,_ . .•r1i:.-... .giXQN `A r !:i E0RIfET#ONI_ _'4v <br /> - Seyt <br /> I. <br /> EMI <br /> OWNER NAME: i_r.l , _ N . �, TENANT BUSINESS NAME If Commercial : L <br /> OWNER MAILING ADDRESS: STREET , r - -• I.CITY •` i STATE r <br /> ZIP % , <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Al 4 lRO Z-Z- _ ^h <br /> CONTRACTOR ADDRESS: STREET <br /> - CITY a2, - STATE ,,I♦ ZIP a <br /> CONTRACTOR PHONE: / ' ,,' =j 4 & CONTRACTOR EMAIL: a -'f. , ; s ', = ' <br /> CONTRACTORLIC.#t(REQUI- �I CITY OF EVERETT BUSINESS LIC-#(REQUIRE..IW �' <br /> PRIMARY CONTACT: ❑ HE <br /> O , - -= •' ❑OTR(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Abe?- e 7 — 3 fe <br /> CONTACT EMAIL: • 1,4 bid <br /> Jr , •i i 41 <br /> AGREEMENT:I hereby cerfily that 1 have rya•and examined this appticairbn and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> typo of work r • •e co .feted whether specified herein or not The granting of a permit does not presume to give authority to violate orcancel the provisions of any otherstate or <br /> local law re-uiating cons cilon or the performance of construction. That I em authorized by the ownerof this property to perform the work for which application Vs made and 1 <br /> comply wi the State Con Tactors aw 18.27 RCW end 296.200 WAG. CI of Everett Official Uso Ont <br /> PERMIT#1:_ <br /> E `�02 -- CDS <br /> 1. - -- - -------- ---._ _ - -- - <br /> Owne•Autho:•-d Age ignature Date` (Revised 1111/2019) Page 1-Application <br />