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MN <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I wwwr.evorettwa.gov/permits <br /> PROJECT SITE INFORMATIION. .'` ,? <br /> PROJECT ADDRESS: 3301 3'1 st DR Everett 98291 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION&DESCRIPTION OF:INORK <br /> CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> (2)alter 15 amp circuits for lighting <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO El YES-Select Scope:❑Service ❑ Feeder ❑✓ Circuits-#:2 ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: <br /> ❑Intercom ❑Secure Access ❑Security System <br /> SELECT SCOPE(REQUIRED): �Data ❑Thermostat ❑Audio <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 /> ❑Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO ❑YES—See Below&Pg.2 <br /> ---1 By checing this box,I am <br /> ,selected the <br /> on page <br /> fic <br /> n <br /> of this application(see next tp ge) AND Plan Review is NOT required becau e I meetll <br /> alof the following subisectionsothat do not 2 <br /> See Page 2 require Plan Review. �1 <br /> ARE YOU AN OWNER <br /> Pursuant toPERFORMING <br /> 19.28.261,property owners andel lease oldersR Hcannot perform electT ELECTRICAL rical work on buuilldings for rent,sale,orrilease <br /> Pg.3 <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: Daniel Ronquillo TENANT BUSINESS NAME(If Commercial: <br /> OWNER MAILING ADDRESS: STREET 3301 31st DR WA ZIP 99201 <br /> c„ Everett STATE <br /> OWNER PHONE:na <br /> OWNER EMAIL:na <br /> CONTRACTOR NAME: In House Electrical Services, <br /> DR, In <br /> CONTRACTOR ADDRESS: sTHEET150zip eersaa2s7suzos <br /> STATE WA <br /> �m Lake Stevens <br /> CONTRACTOR PWONE:4257603203 CONTRACTOR ECI Y OihFEEVEREermITTBU NESS LIIC.#(REQUIRED):044166 <br /> CONTRACTOR LIC.#(REOUIRED):inhoues952gg <br /> PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT PHONE:4253209149 <br /> CONTACT NAME:ke I S eY <br /> 1 CONTACT EMAIL:ihepermits@gmail.com <br /> that!have read and examined this application and know the same to be true and correct Alt provisions of laws and ordnances govemtng this <br /> AGREEMENT:work T.i I herebycompletedetlyn to <br /> viN the or cn for which application is made and I <br /> locatypel <br /> of work will be whether• the performance ce of con nI ction.grantingThat 1 am authorized try the owner of this property <br /> to ped orm thCi cancelof which pplic ti Use Ont er s d e or <br /> local law raga: a construe rP <br /> p! wi the ate Co recto', :. 7RCWand 2.6'OD WAG. PERMIT#:comply <br /> , �I 0 I E V , + b�- <br /> /4ilPr (Revised 1/11/2019) Page 1-Appfcatlon <br /> Owner/Aute fzed •s-nt SWre r Date <br /> Scanned with CamScanner <br />