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MINI <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERb i.WA 98201 <br /> IP)425-257-8810 I FAX 425-257-8857 I(E)everettaps@everettwagov I www,everatiwa.goviperrnits <br /> PROJECT'SITLINFORMATION <br /> PROJECT ADDRESS: 2 West Casino Road BUILDING AREA: sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION 0 TENANT INIPROVMENT Z REMODEL <br /> BUILDING USE: LI SFR El TOWNHOUSE 0 DUPLEX 0 ADU 7:,,,D MULTI-FAMILY-#OF UNITS: 17 COMMERCIAL <br /> AtsgpIgicA4,,A0pLocATtottloifoRmATIOtt 4,Daspftivriotcof:10,0*., . <br /> „ . „„...,......, <br /> CONTRACT PRICE OF WORK:$ 800 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install new feeder to Unit#156 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? NO El YES-Select Scope:El Service 0 Feeder 0 Circuits-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED); 0 Data El Intercom 0 Thermostat 0 Audio El Secure Access D 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 /> El Other(List All). <br /> . „ <br /> 06DL -OrlitkU,:..174V.ILItt; - : ' 14 l . <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO El YES—See Below&Pg, 2 <br /> By checking this box,I am stating that I have read and understand all of WAC 29646B-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: Lo.riN0 LIVES-See Below&Pg.3 <br /> — Pursuant to ROW 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 /> Caiter*ribiFORMATIOW <br /> OWNER NAME: The Bluff At Evergreen TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sinEET 2 West Casino Road <br /> CITY Everett S'TATE WA z,98204 <br /> OWNER PHONE: 425 3534950 OWNER EMAIL: <br /> CONTRACTOR NAME: Boyer Electric Company Incorporated <br /> CONTRACTOR ADDRESS: STREET 8119 240th St SW <br /> on Edmonds STATE WA zt, 98026 <br /> CONTRACTOR PHONE: 206 367-7606 CONTRACTOR EMAIL: karen@boyerelectriczom <br /> CONTRACTOR LIC.*REQUIRED): BOYEREC101LE CITY OF EVERETT BUSINESS LW,*REQUIRED): 22147 <br /> PRIMARY CONTACT: DOWNER ECONTRACTOR LIOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 367-7606 <br /> Karen Hanson CONTACT EMAIL: karen@boyerelectric,com <br /> AGREEMENT:I hereby certify that i have read and examined Vile application and know the same to be true and correct All provisions of laws and ordinances overflow thin <br /> type of work war'be completed whether specified rurein or not. The granting of a permit does not presume to give authority to violate or cancel the provisiens of any other state or <br /> local taw regulating construction or the performance of construction That tarn authorized by the owner of this property to perform the work for which eppkation is made and! <br /> comply with the State Contractors Law 1827 i7CW and 296.200 WAC City of Everett Off*Ial Use Only <br /> PERMIT#.. <br /> 1), <br /> th <br /> WTI ri orized Agent Signature <br /> Date 7 / ' <br /> E i, 1(„. --:, - <br /> , ,, , -/. <br /> '(Revised 1/1112019) Pagei-Apptication <br />