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ELECTRICAL PERMIT &s FIRE ALARM PERMIT APPLICATION. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 f FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> .. e�� .�.�- .�•..,.-":',:l'',,4 E x,„� .w,> .rte. ..�z .,. 1:'4,-14 ‘ \'l .,z:., <br /> .�. m>.�_ ..,.;, „�, ..s;s�tea <br /> PROJECT ADDRESS:1517 Rockefeller Ave <br /> PROJECT TYPE N € EW CONSTRUCTION .II ADDITION NANTIMPROVMENT EMODEL 1 in . , <br /> BUILDING USE �,-FR `j 0 J OWNHOUSE ;CI *UPLEX , D U ULTI-FAMILY-#OF UNITS COMMERCIAL <br /> BUILDING AREA: 1.,066 <br /> esqft <br /> CONTRACT PRICE OF WORK.$6,400 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> NIS THIS LOW VOLTAGE WORK? 0 NO CI ;, S-#OF DEVICES; <br /> IS THIS A FIRE ALARM PERMIT? O CI YES-Plans required for review(Both Electrical and Fire Department <br /> r _„ p inspections are required) <br /> DESCRIPTION OF WORK: 2circuits,11 outlets,2 switches,9 fixtures. Please be advise we would like this added to <br /> is permit that we already have open. E1804-116 <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <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 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 /> 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 /> �. � � CI ,'� s " ,, ��8 s ic« &,, <br /> OWNER NAME Beth Peterson TENANT.BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1517 Rockefeller Ave <br /> crry Everett STATE WA zip 98201 <br /> OWNER PHONE: 206-437-2450 OWNER EMAIL: batbethl4@gmail.com <br /> CONTRACTOR NAME: Exact Electric, LI_C <br /> CONTRACTOR ADDRESS: STREET 10115 Greenwood Ave N#233 <br /> cnv Seattle <br /> STATE WAZIp 98133 <br /> ONTRACTOR PHONE:206-434-6915 CONTRACTOR EMAIL Info mexactelectric.corn <br /> CONTRACTOR LIC.1/(REQUIRED):EXACTEL927RK <br /> CIT. <br /> YOF �BUSINESS 41C.#(REgUIRED} 051205 <br /> PRIMARY CONTACT: WNER eeNTRACTORYTHERPiease Specify) <br /> - <br /> CONTACT`NAME CONTACT PHONE 206-434-6915 <br /> Jasmine Kaiser <br /> CONTACT EMAIL tasmmeexactelectric.com <br /> AGREEMENT I hereby certify that/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 lam 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 /> PE�iMI # _ <br /> ai <br /> // fTo1 <br /> e <br /> 1lgb� 11C� <br /> orized Agent Signature Date (Revised 10/30/2018) Page 1 of 3 <br /> 11 ( <br />