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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE -, IT +8201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@evere ro:gov I .everettwa.gov/permits <br /> „„,,,,,,e . .`.«.'n ....: z`. `.,sti.>,,,,::, t .\„ ,. ATIO a'.is YZ r, <br /> PROJECT ADDRESS: 3003 WEST CASINO ROAD BLDG 40-56/E1 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ ADDITION ❑TENANT IMP'OVMEy ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL <br /> lam` ,;:,r ? ATIOCA ...APPLt 4 O 1, • ,;M.ATI:ot RSI sORwi ION O . .. =g IA <br /> CONTRACT PRICE OF WORK:$ 500 (ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Provide Power to roll up door El 5B <br /> Job 19BX <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 <br /> SELECT SCOPE(REQUIRED): ❑✓ Data ❑ Intercom ❑Thermostat ❑Audio El 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): <br /> illattrWiff 1, , F <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: D NO • YES--See Below&Pg.2 <br /> I I 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: ✓❑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. <br /> ,: 3 CONTACT-Ai <br /> , A .yds <br /> OWNER NAME: THE BOEING COMPANY TENANT BUSINESS NAME(If Commercial): THE BOEING COMPANY <br /> OWNER MAILING ADDRESS: STREET PO BOX 3707 MS 1 F09 <br /> cin. SEATTLE STATE WA ZIP 98124 <br /> OWNER PHONE:(425)294-0514 OWNER EMAIL: <br /> CONTRACTOR NAME: DUTTON ELECTRIC COMPANY, INC. <br /> CONTRACTOR ADDRESS: STREET 12407 MUKILTEO SPEEDWAY A-170 <br /> CIT' LYNNWOOD STATE WA zip 98087 <br /> CONTRACTOR PHONE:(425)347-7600 CONTRACTOR EMAIL:info@duttonelectric.com <br /> CONTRACTOR LIC.#(REQUIRED):DUTTOEC137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019811 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425)409-4854 <br /> Brad Morin CONTACT EMAIL:brad@duttonelectric.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 WAC. City of Everett Official Use Only <br /> PERMIT#: �/ <br /> Peita Smith Algitally signed by Peita Smith E c `a5 r- \ ` Co <br /> ,.Da te:2 D 19.05.28 12:05:27-0700' <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />