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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION
<br /> ,,. :I r'r t°af 1-VFR.E-IT PERtv91T ',11'
<br /> f it it, , 1lIAR SSTRI"I 1 I-VFRET I `I'�%°�, `ri'='°'_
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<br /> dl )42h 2h' O' 1 1:Aa (12f 297"-8867 I (F)evnietlelsrbsi.6(vvoieltws't i i °'io wvw v/rrrti t.€ta ° iv.(:.rrriits
<br /> PROJECT SITE INFORMATION
<br /> 1. PROJEC"t`AOUPESS:i _ ' s:.,_._ ".�i . . ,, t m ` 1 �..
<br /> PROJECT TYPE' LLEJI NF:W CONS t Rt.l i ION Al'If a t tt)N Q't I NAN t IMPROV€N'I f„'i RE-1001)1,1
<br /> BUILDING USE: 0:"FR 0 TOWNNHi O F 0 I)t.Ill E X 0 5i l) t#n T1,FAtwilt r , _lett ,`))`ti i s l
<br /> BUILDING AREA :"2""),"('
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> . jASSr C0 BUILDING PERMIT#i=f apph affil t r r° ,
<br /> CONTRACT-----PRICE OF WORK; 6 ` TED '�
<br /> IS THIS LOW VOLTAGE WORK? NO E`.) f-tr t IF O ''. r
<br /> ir't ..._ .__......,m
<br /> IS THIS A FIRE ALARM PERMIT? YES I'Niis reg iro(9 for review(Both f..lectric l ;-)Flet F ire Dopartrnorrt insp.-btu/rib,are require/1/
<br /> DESCRIPTION OF WORK +fir CODE (COMPLIANCE
<br /> DESCRIPTION OF WORK: ;C.')4,../ :i,"'", ,� < i I< ,2t1, in .'.. _J i le + i I, r"'fit I,, " ' ,,,.J..
<br /> (-' Ic' lel ') \ _
<br /> THIS SECTION .-'PLt TO ALL EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> I1 i By checking this boxtam stating that I have read and iiriderstarid all of WAC 295-d6B-9OO, selected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required br=t:ause I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review,
<br /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE
<br /> Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent sale,or teaie mthriu4
<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
<br /> Page 8 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirerrtent.
<br /> CONTACT INFORMATION
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial}:
<br /> OWNER MAILING ADDRESS: STREET( i'' t,, V
<br /> CITY ��v.\,qtr--:.,I,.:_`�
<br /> OWNER PHONE:-` �t - Y--ti�:„:�J-k " OWNER EMAIL:
<br /> :ONTRACTOR NAME: `,(X l j C�� � J ice.
<br /> :ONTRACTOR ADDRESS: srrstct -[3 V. j.._. _t" ". ,,
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<br /> CITY 't. 1 ISTATE ---- Ctf- —' Y t .�
<br /> ONTRACTOR PHONE:(5 1 ..r a)5 CONTRACTOR EMAIL:C'/ iy ,().,c 'p (,, 'i ' k,._.‘,.,.-._1''''1,:. 4,v` 'i----,s---.1
<br /> ONTRACTOi2 LIC.#(REQUIRED): 4 CITY OF EVERETT BUSINESS LIC. # EOI (RED
<br /> forty
<br /> IMARY CONTACT: Lb, OWNER CONTRACTOR OTHFFR (Please Specify;wok , !` A
<br /> ?NTAGT NAME: CONTACT PHONE: 6e)NIC-S)
<br /> CONTACT EMAIL:
<br /> R EM NT I hereby certify that 1 have read and examined this applicairorr arid know the same to he true and correct. Alt previsions of taws and ordinances
<br /> 'arming tilts type of work will be completed whether spec/tied herein or not. The granting of a permit does not presume to qwe authority to violate or canal the
<br /> asiions of any other state or WO law regulating construction or the perforrnanee of construction, That/ant nut razed by the owner of this proi,eriy to perfoMt the
<br /> k for which application is madif'a*/'Comply with the State Contractors taw 18.227 RCVV and 296,200 WAC
<br /> City of Everett Official t,;,e Onip
<br /> PERMIT
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