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ASSOCIATED BUILDING PERMIT # (if applicable): o See Page 2 o See Page 3 E Owner/Authorized Agent Signature Date (Revised 4/5/2022) o Other (List CONTRACT PRICE OF WORK: $ DESCRIBE SCOPE OF WORK: o Data o Intercom o Thermostat o Audio o Secure Access o Security System LOW VOLTAGE WORK? o YES- # of LINE VOLTAGE WORK? o YES - Select Scope: o Service o Feeder o Circuits-#:______ o Complete Re-wire o NO o NO SELECT SCOPE (REQUIRED): IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: o NO o YES See Below & Pg. 2 BUILDING USE: o SFR o TOWNHOUSE o DUPLEX o ADU o MULTI-FAMILY - # OF o COMMERCIAL ELECTRICAL PERMIT APPLICATION PROJECT ADDRESS: PROJECT TYPE: o NEW CONSTRUCTION o ADDITION o TENANT IMPROVMENT o REMODEL [PHONE REDACTED] I [EMAIL REDACTED] I www.everettwa.gov/permits PROJECT SITE INFORMATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 BUILDING AREA: ft CODE COMPLIANCE ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK o Fire Alarm - Installations under this permit only include electrical wiring rough-in of the system. An additional Fire Alarm Permit is required for review of device location and installation approval. Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. OWNER EMAIL: CONTRACTOR NAME: OWNER MAILING ADDRESS: STREET TENANT BUSINESS NAME (If Commercial): OWNER NAME: OWNER PHONE: Page 1-Application o OWNER o CONTRACTOR o OTHER (Please Specify) CONTACT EMAIL: PRIMARY CONTACT: CONTACT NAME: CONTACT PHONE: 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 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only CITY OF EVERETT BUSINESS LIC. #(REQUIRED): CONTRACTOR LIC. #(REQUIRED): PERMIT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) 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 of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not require Plan Review. CONTACT INFORMATION CONTRACTOR PHONE: CITY STATE ZIP CITY STATE ZIP CONTRACTOR EMAIL: CONTRACTOR ADDRESS: STREET ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: oNO oYES -See Below & Pg. ---PAGE BREAK--- Electrical plan review. o o o o o o o o o o o E Owner/Authorized Agent Signature Date (Revised 11/21/2025) NOTE: Electrical plan review is not required for "Medical, dental, and chiropractic clinic" of which is a clinic or physicians' office where patients are not regularly kept as bed patients for twenty-four hours or more, per section (1)(c)(xii). Page 2 - Plan Review If a review is required, the electrical plan must be submitted for review and approval before the electrical work is begun. Does not involve branch circuits or feeders of an essential electrical system as defined in NEC 517.2; and Service or feeder load calculations are increased by 5% or less. (vi) Electric power production source(s) such as solar photovoltaic, fuel cell, or wind electric system(s) with a total rating of 9600 watts or less. 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 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only WAC 296-46B-900: ELECTRICAL PLAN REVIEW EXEMPTION WORKSHEET Low voltage systems; (ii) Lighting specific projects that result in an electrical load reduction on each feeder involved in the project; (iii) Heating and cooling specific retrofit projects that result in an electrical load reduction on each existing feeder involved in the project, provided there is not a corresponding increase in the available fault current in any feeder. (iv) Stand-alone utility fed services that do not exceed 250 volts, 400 amperes where the project's distribution system does not include: Electrical plan review is not required for: DIRECTIONS: Read the WAC section below to determine if plan review is required or not required. Then select the box next to to tell City Staff if plan review is not requried and select the box next to the specific reason from WAC 296-46B-900. If plan review is required, select the box next to and to acknowledge that plan review is required and the electrical plans have been provided with this permit application. * If item iii, or v) is selected, the work must also comply with section (a)-(vii). See arrow flow chart below. PERMIT Emergency systems other than listed unit equipment per NEC 700.12(F); An essential electrical system defined in NEC 517.2; or A required fire pump system. Modifications to existing electrical installations where all of the following conditions are met: Service or distribution equipment involved is rated not more than 400 amperes and does not exceed 250 volts or for lighting circuits not exceeding 277 volts to ground; Does not involve emergency systems other than listed unit equipment per NEC 700.12(F); Electrical plan review is required for all other new or altered electrical projects in educational, institutional, or health care occupancies defined in this chapter. (vii) For installations in (iii), and of this subsection to be considered, the following must be available to the electrical inspector (on-site or uploaded to the permit) before the work is initiated: A clear and adequate description of the project's scope; A load calculation(s); What the load changes are, providing both before and after panel schedules as needed; and Provide information showing that the service and feeder(s) supplying the panel(s) where the work is taking place has adequate capacity for any increased load and has code compliant overcurrent protection for that supply. ---PAGE BREAK--- o OR o o o AND o o o o o o o o o City of Everett Official Use Only PERMIT Date (Revised 11/21/2025) ELECTRICAL PERMIT AFFIDAVIT A property owner, renter or lessee may purchase a permit to do an electrical installation on his/her own or qualified leased property under the conditions as described in RCW 19.28.261. I am applying for the property owner exemption under the following conditions: I swear under penalty of perjury that I am: A nonprofit corporation with current tax exempt status or a nonprofit religious organization may purchase an electrical permit as described in RCW 19.28.091(7). Code Exemptions: I swear under penalty of perjury that: You must select the option that applies to your situation: I am a registered general contractor who is installing a temporary electrical service owned by me on a project where I am the general contractor The owner of real property; or The renter or lessee of real property. (You must provide a signed letter from the owner of the property granting permission for you as the tenant to perform electrical work on the property); or A new construction single family residence THAT IS NOT intended for rent, sale, or lease AND I will be personally doing the electrical work AND I will occupy the residence for at least 24 months after completion of the electrical work; A NEW 2, 3, or 4 unit residential property that IS intended for rent, sale, or lease AND myself and/or a regularly scheduled and paid employee(s) will be doing the electrical work AND I will occupy one of the units for at least 24 months after completion of the electrical work. An EXISTING 1, 2, 3, or 4 unit residential property that IS intended for rent, sale (minimum 12 months after obtaining the property), or lease AND myself and/or a regularly scheduled and paid employee(s) will be doing the electrical work; A farm AND I, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work; A nonprofit corporation that holds a current tax exempt status as provided under 26 U.S.C. Sec. 501(c)(3) or a nonprofit religious organization, and the total value of the electrical work does not exceed thirty thousand dollars ($30,000.00). You must select the option that applies to your situation: Owner Name (Print) Owner Signature An EXISTING place of business AND I, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work; A NEW place of business that is NOT intended for rent, sale, or lease AND I, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work; or Other property that is NOT intended for rent, sale, or lease AND I, personally, and/or a regularly scheduled and paid employee(s) will be doing the electrical work. I am a nonprofit corporation that holds a current tax exempt status as provided under 26 U.S.C. Sec. 501(c)(3) or a nonprofit religious organization and the total market value of the electrical work does not exceed thirty thousand dollars ($30,000.00), and the electrical work will be performed by appropriately certified electricians or certified and supervised trainees who are volunteering and not being compensated for electrical work per RCW 19.28.091(7). I AGREE and wish to purchase an electrical permit under the conditions described above. E Page 3 - Affidavit