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11 = z5,9I/(0. I qo ( 71 ) • <br /> eLECTRICAL PERMIT APPLILATION <br /> / 1 .., CITY OF EVERETT PERMIT SERVICES <br /> � L 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> L-1 PROJECT ADDRESS: ,'-10- 3 1 16_,....t'tC rri ( ( g I l BUILDING AREA: sq ft <br /> PROJECT TYPE: CI NEW CONSTRUCTION ElADDITION❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> .' ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ (3f 1 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> i <br /> DESCRIBE SCOPE OF WORK: Lv1< d c SP I r )- tr7 <br /> Ps• \---tIckii. Li bo V i''oov j <br /> e_D- . V w`:> -ci I ( On4-r a IS 4'" t al y.e t,'t j -Co\f -;-LTh, <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO 5YES-Select Scope: El Service ® Feeder C] Circuits-#: 2 El Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 7 YES-#of Devices: PLC Ca J> <br /> SELECT SCOPE(REQUIRED): El Data ❑ 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): <br /> ... CODE COMPLIANCE <br /> fjS,THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO ❑YES--See Below&Pg.2 l' <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 /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: I,,NO EYES-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. <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Boeing <br /> OWNER MAILING ADDRESS: STREET PO Box 3707 <br /> an, Seattle STATE WA ZIP 98124-2207 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: General Construction Company <br /> CONTRACTOR ADDRESS: STREET PO Box 46 <br /> erry Mukilteo STATE WA zip 98204 <br /> • <br /> CONTRACTOR PHONE:425-294-6944 CONTRACTOR EMAIL:Bridgett.Burns@Iciewit.com <br /> CONTRACTOR LIC.#(REQUIRED):GENERCC9840Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 040599 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-730-6546 <br /> Dennis Crow CONTACT EMAIL:Dennis.crow@kiewit.com . <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 State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only <br /> PERMIT#: <br /> Ai_ (0-10) E VA 02 -02,14Owner/Auth�d Age Ignature DateRevised <br /> ( 1/11/2019) Page 1-Application <br />