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ELECTRICAL PRMIT & FIRE ALARM PEIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> - 3200 CEDAR STREET, EVERETT,WA 98201
<br /> vett (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS:3729 Smith Street
<br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
<br /> BUILDING AREA: 100 sq ft
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<br /> CONTRACT PRICE OF WORK:$1500.00 ASSOCIATED BUILDING PERMIT#(if applicable):n/a
<br /> IS THIS LOW VOLTAGE WORK? ✓❑ NO El YES-#OF DEVICES:
<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: 30A feeder, loadcenter, unit heater, receptacles, lights
<br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO ❑YES--See Below&Pg.2
<br /> In 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 /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO EYES-See Below&Pg.3
<br /> riI I 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.
<br /> ire x CONTAdT INFORMAtioN' f _ ,�°"'}
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Petro Card
<br /> OWNER MAILING ADDRESS: STREET
<br /> CIN STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME:Innovative Electric, Inc.
<br /> CONTRACTOR ADDRESS: STREET PO Box 4399
<br /> CITY Everett STATE WA ZIP 98204
<br /> CONTRACTOR PHONE:4252907803 CONTRACTOR EMAIL:jim@innovative-electric.com
<br /> CONTRACTOR LIC.#(REQUIRED):INNOVEI055KE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 36828
<br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR LI OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-571-3948
<br /> Jim Yen ci ch CONTACT EMAIL:jim@innovative-electric.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 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> w /Authoriz ent Signature ate (Revised 11/5/2018) Page 1-Application
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