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■�=CTRICAL PERMIT APPLI __ _TION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425t-257-8810 I FAX 425-257-8857 I(E)everette--p++s@eveerettw/�a.gov I wrowv.everettwa.gov/permits
<br /> gi'�Lf y`;"'f T �2x r s ':2'F}r rS ��y R A,p w INFOR A\TIIO d �rr� li$. .��� qty i'o- i r��N 1'`` 4t t it
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<br /> PROJECT ADDRESS: 2505 Pacific Ave BUILDING AREA:_ sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
<br /> „it3'r_µt t `" g .c.i •4.01tiatregeMIPAINVQ,RMATIOI+ ' MMl 1PTIrQNSO ` MaaiMa';i
<br /> CONTRACT PRICE OF WORK:$ 2500 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Quarterly Maint: Repalcing lamps and ballast throughout the interior and and exterior.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO El YES-Select Scope: El Service ❑ Feeder El Circuits-#: ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑ Thermostat ❑Audio El Secure Access ❑ Security System
<br /> El 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 /> t�.•t acv:.. �, r -chi"l, d'"'f k' Mb$�-.n�i 7 I 1 $�'�° * ,+nW -+,' rygww.. v , ti
<br /> "`°'r s i CO 2GOMFVAN
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: El 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-900,selected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required because l meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 7 N EYES-See Below&Pg. 3
<br /> Pursuant to RCW 19.28.261, 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 /> Pl�' , TE t:� ; II {>I q ` RAN T INFOAMrATIPA a��:.,Y {. t ,� -���� r h tw
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<br /> OWNER NAME: Lowes Companies TENANT BUSINESS NAME(If Commercial): Lowes
<br /> OWNER MAILING ADDRESS: STREET 1000 Lowes Blvd
<br /> c,n. Moo rseville STATE NC ZIP 28117
<br /> OWNER PHONE:1800-455-6963 OWNER EMAIL:
<br /> CONTRACTOR NAME: West Coast Lighting & Energy, Inc.
<br /> CONTRACTOR ADDRESS: STREET 18550 Minthorn St.
<br /> c,-- Lake Elsinore STATE CA ziP 92530
<br /> CONTRACTOR PHONE:951-296-0680 CONTRACTOR EMAIL:OrWaQ@wcleinc.corn
<br /> CONTRACTOR LIC.#(REQUIRED):EC WESTCCL929B CITY OF EVERETT BUSINESS LIC.#(REQUIRED):047162
<br /> PRIMARY CONTACT: El OWNER ❑✓CONTRACTOR EOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:951-296-0680
<br /> Micah Hazen CONTACT EMAIL:orwa@wcleinc.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 governing this
<br /> 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
<br /> 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
<br /> comply with the State Contractor Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> E HoZ 7 10 0
<br /> Owner/Auth rized Agent '-ature Date (Revised 1/11/2019) Page 1-Application
<br />
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