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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 4.4677 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa goy I www.everettwa.govfpermits <br /> r" . SITE N- j-MA •N <br /> PROJECT ADDRESS: 3339 31st Dr BUILDING AREA: 1381 8 _ sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: C SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> ELECT I AL A A ri T •T-.T r ,; OF.r .• 4 <br /> CONTRACT PRICE OF WORK:$ 500 ,ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> 1 - 30AMP Dedicated Circuit for Heat Pump <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO ❑YES-Select Scope: ❑ Service ❑ Feeder Circuits-#: 1 ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El 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 /> COIblE,,C II PLIA*C <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LvJ NO L YES--See Below&Pg. 2 <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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO EYES-See Below&Pg. 3 <br /> Li 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 /> CON?Acr ORM TION ;:.. ' <br /> OWNER NAME: Marina Palos TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3339 31st Dr <br /> e, Everett STATE WA ,,, 98201 <br /> OWNER PHONE:2064955986 OWNER EMAIL:m.hernandez29@gmail.com <br /> CONTRACTOR NAME: SEATOWN ELECTRIC CORP <br /> CONTRACTOR ADDRESS: STREET 3431 Broadway <br /> CITY Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:2069054946 CONTRACTOR EMAIL:permits@seatownservices.com <br /> CONTRACTOR LIC.#(REQUIRED):SEATOEC86ORB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53916 <br /> PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR LIOTHER(Please Specify) <br /> 'CONTACT NAME: CONTACT PHONE:206-905-4946 <br /> Bekah Swanson CONTACT EMAIL:permits@seatownservices.com <br /> A REEMENT 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 /> 4/2/19 E <br /> Owner/Aut .(rized -1,ent ignature Date (Revised 1/11/2019) Page 1-Application <br />