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<br /> <- ELECTRICAL CAL PE IT APPLt I
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425 257 8810 I FAX 4255-257 88577' 1(E)everetteps@everettwa.gov I wwweverettwa.gov/permits
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<br /> PROJECT ADDRESS: 921 to ��� 2_6 NA)C. (BUILDING AREA: sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION ENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: ❑SFR ❑■�T�OWNHOUSSEE 0 DUPLEX 0 ADU MULTI FAMILY #OF UNITS: 0 COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 2p : 'ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: '(2.F.fFZ0 tk,ATO 1-.V-1, ^pri-oFl A,- (\n1--I- -
<br /> ?ir4t s TD MEET ce - (W1 a- 'Ec im fz I If Z)
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service-Feeder 0 Circuits-#: 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED):
<br /> 0 Data 0 Intercom 0 Thermostat 0 Audio .0 Secure Access 0 Security System
<br /> ❑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): //�� {x' ys
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: laNO 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 /> 11:3 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE' NO DYES-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.
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<br /> wig x„ .3 Y„1 )wiz �, hi'3 ,,�'�`<2' N E, i w ] ON A�r., PA �:z'�`.z"i` ?a�,�k,�.s" '�.. i->.. `e,��'.r':T-', fti�..�,',mr c.,..s's.....M .. .. .. .xw
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<br /> OWNER NAME: -ssz,N1•—.) I.--j TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET `2Zl(. bi FA6
<br /> FJV
<br /> CITY STATE IA)* ZIP CM(0
<br /> OWNER PHONE: DOWNER EMAIL:
<br /> CONTRACTOR NAME: RAT-1--) S-177—ECC— 2-C C-
<br /> CONTRACTOR ADDRESS: STREET Rb eicx. /.6Sl�CITY [yam�q
<br /> STATE LA)W 1 L ZIP `C7CJZ0
<br /> ET��.O ,
<br /> CONTRACTOR PHONE: Z, -7G—, --17t3 (CONTRACTOR zatuai 0im,wrN3r2 71---c. 'e•car..
<br /> CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OS�L/ �"
<br /> CONTRACTOR LIC.#(REQUIRED art' - ��`Z pK.. " ` `°'"
<br /> PRIMARY CONTACT: DOWNER 116; ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (42_S-, .7`� ----,ZZs2) 1
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<br /> i3 CONTACT EMAIL: l ...i j/ �t YVtIc��T"EL-Ec 2 .CO k
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<br /> AGREEMENT:workwill
<br /> hery certify th t I r have readande examined thisapplication
<br /> granting
<br /> of a permit does not presume know rde to give authority to violate correct. All or cancel the provisions oaws and ordinances f any other overning state or
<br /> type of work will be completed whether specified herein or not. The granting
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work
<br /> r f Ewhicht CONTACT lNAM
<br /> Use made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. CPERMIT#:
<br /> r4®` I0//01 E k.ccO( — r �
<br /> 1+`re (Revised 1/11/2019) Page 1-Application
<br /> Owner/�, � ized Ag-nt'rgnature Da
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