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ELECTRICAL IiHRMIT & FIRE ALARM PETIT APPLICATION <br /> 017- r <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: hi/V? Fveince- i mie �/ <br /> n <br /> PROJECT TYPE: 0 NEW CONSTRUCTION_ / / <br /> In ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 13 COMMERCIAL <br /> BUILDING AREA: /040 sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 5060 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO EYES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? ®.NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are.required) <br /> DESCRIPTION OF WORK & CODE�COMPLIANCE <br /> DESCRIPTION OF WORK: C'O X/Dtche- � earns . "7 r 4 . e'cu -, / deI,/ces <br /> 2 S/ail tad41 e— s a c1 ,4/a-• (i�har.&',Pi et y <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: .NO 0 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ISNO OYES-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 without <br /> the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME:6Uaf i/7 bpd e.e„..,4 --.C TENANT BUSINESSNAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET y fif t G(/e rreor <br /> CITY (VZ -e j! STATE (jet. ZIP /8-2,3 <br /> OWNER PHONE:. '/2c- 20-�P� 4242//r/OWNER EMAIL: / yy�• <br /> CONTRACTOR NAME: il/Ge>( ZecAices / $ph##z9 SJ .Z> e . <br /> CONTRACTOR ADDRESS: STREET IX/ S/.' Alk 40Q,h 2e/ <br /> CITY Zack scc;egb STATE eye. ZIP 9762,3 <br /> CONTRACTOR PHONE: fJ3-6,8y-9,611 CONTRACTOR EMAIL: .S,r3c .7trS tQ 413 PA-7-4 . GOK-1 <br /> CONTRACTOR LIC.#(REQUIRED): f}pp/.r j s .046,C1) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): - <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: cb 3_ 7c13-74/Zi <br /> 6 OC ,cJc S CONTACT EMAIL: s� feS e A- A/1'7A. C'O.'V1 <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 <br /> 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 <br /> 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 <br /> work for which application is made and!comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /elf Gn <br /> 'Y-\ <br /> Owner/Authorized Agent Signature (Revised 11/5/2018) age 1-Applicatio <br />