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2019-05-03 11 :08 Stevens Creek 4253340108 >> 425 257 8857 P 1/2
<br /> ECTRICAL PERMIT APPL NATION
<br /> E'l R E T T 32CITY OF EVERETT PERMIT SERVICES
<br /> 00 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsceverettwa.gov i vww.everettwa.gov/permits
<br /> 79HINCTON
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<br /> PROJECT ADDRESS: 1428 Wetmore Ave BUILDING AREA: 1500 sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑✓ REMODEL
<br /> BUILDING USE: El SFR ❑TOWNHOUSE ❑ DUPLEX ❑ ADU CI MULTI-FAMILY-tf OF UNITS: El COMMERCIAL
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<br /> CONTRACT PRICE OF WORK: $ 300 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Gas furnace being put in.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: {SELECT ALL THAT APPLY)
<br /> LiNE VOLTAGE WORK? El.NO ❑✓ YES-Select Scope: El Service El Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? 0 NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat ❑Audio ❑ Secure Access El 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):Gas Furnace
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<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: - NO I. YES--See Below&Pg. 2
<br /> n 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg.3
<br /> 7,71 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale,or lease
<br /> I" I 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 /> OWNER NAME: Jeffery Olson TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1428 Wetmore Ave
<br /> Everett STATE WA ZIP 98201
<br /> OWNER PHONE:360-708-2776 OWNER EMAIL:lefferydolSOn@hottTlall.COnl
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<br /> CONTRACTOR NAME: Owner
<br /> CONTRACTOR ADDRESS: STREET
<br /> - -
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: [CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): _ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
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<br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:360-708-3962
<br /> Jeffery Olson CONTACT EMAIL:jefferydolson@hotmall.com
<br /> AGREEMENT:I hereby certify that I have reed and examined this application and know the same to be true and correct. Al!provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or not. Thc 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 em authorized by the owner of this property to perforin the work(or which application is made and I
<br /> comply with thr State Contractors Liv 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:x),,,t,k_ .
<br /> Ow e I (tithb d Agent Signature Date (Revised 1/11/2019) Page 1-Application
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