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03/20/2019 15 : 17 #4092 P. 001/001
<br /> dLECTRICAL PERMIT APPL1%-MTION
<br /> 41lit
<br /> ..._. CITY OF EVERETT PERMIT S1 RVICES
<br /> ii"W3200 CEDAR STREET,EVERETT,WA 90201
<br /> }}'',, t (P)4125-257-8810 1 FAX 425-257-8857 I(E)everetteps everettwa.gov I w.wN.everettw�a-gov/permits ,S
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<br /> PROJECT ADDRESS: 5710 SUNSET LANE —
<br /> BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: Q SFR El TOWNHOUSE ❑ DUPLEX ❑AIu ❑MULTI-FAMILY-#OF UNITS: Q COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:S 3400 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE SERVICE PANEL WITH GENERATOR PANEL
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? Q NO ❑YES-Select Scope: f1 Service ✓0 Feeder ❑Circuits-4#_ E Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ 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 /> El Other(List All): .
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: F4 NO • YES—See Below&Pg.2
<br /> — By checking this box, I am stating that I have read and understand all of WAC 296-468.990,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: ✓ZNO EYES-See Below&Pg. 3
<br /> HPursuant 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, 1 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:WES & NABCEY DAWSON TENANT BUSINESS NAME If Commercial):
<br /> OWNER MAILING ADDRESS: sTREir 5710 SUSET LANE
<br /> ci-- EVERETT STATE WA zip 98203
<br /> OWNER PHONE:425.513.2160 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES & SERVICE
<br /> CONTRACTOR ADDRESS: STREr3601 EVERETT AVE
<br /> cITY EVERETT STATE WA 21p 98201
<br /> CONTRACTOR PHONE:425.259.2161 {CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363
<br /> PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ['OTHER(Please Specify)
<br /> CONTACT NAME:CO R N U S CONTACT PHONE:425.231.2275
<br /> CONTACT EMAIL:
<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 Ste Contractors Law 18.27 RCW and 298200 WAC. city of Everett Official Ube Only
<br /> PERMIT#:
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<br /> IJP
<br /> Ow ! tit 0 ed Agent glgnature 0:i/4
<br /> E (Revised 1/1 /2019) Page 1-Application
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