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ELECTRICAL PMIT & FIRE ALARM PrMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 352.0 14-1-tet v1/4/4 ciE20`
<br /> PROJECT TYPE: El NEW CONSTRUCTION ©ADDITION El TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: E SFR El TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL
<br /> BUILDING AREA: Iss L sq ft
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<br /> CONTRACT PRICE OF WORK: $ k000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? ❑ NO C' 'YDS-#OF DEVICES:l
<br /> IS THIS A FIRE ALARM PERMIT? 0 NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required)
<br /> f t.wr r i it :DESCRIPTIO 11�ORK&CODE COMPP IANCE nef m,h.
<br /> DESCRIPTION OF WORK: cid C-lrc!fi/j,l f-- eor AC ins{-a)
<br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [9TO ❑YES--See Below&Pg.2
<br /> ErBychecking 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: ONO EYES-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.
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<br /> CONTACT INFORMATION S ,:,,1,1,,,0%,,-,:ii. ,, i
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<br /> OWNER NAME:Mpf9'14- 62.01qt.its TENANTBUSINESSNAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3 ix” 11,441 1 Q'
<br /> CITY overa÷- �fr ZIP C7 2I
<br /> OWNER PHONE:LI.W -950-322-L' OWNER EMAIL:J(%by D n ntS 0 h O 1fl4-I l• co fl
<br /> CONTRACTOR NAME: Q/ i',GYI--2-"”" r ,,,
<br /> CONTRACTOR ADDRESS: STREET q' "� 21x " S T S t sAe. `1
<br /> CITY Mpu iia-rtexcA,CeSTATE W f- , ZIP (it O43
<br /> CONTRACTOR PHONE: ii9-91--1-‘39 CONTRACTOR EMAIL: on.-c, Z 1U1IJ(-2.EIO flailing COt ricoif sCOYIi'1
<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):p52.• 0
<br /> PRIMARY CONTACT: 1WNER INTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 02. 9- -t 1 3 1
<br /> ZVI 1 t J Y"v 1 CONTACT EMAIL: r,N� ?la(te alyC ,�(i_., ca/y-1
<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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT
<br /> 't44/6-,)r lzltu/la \(6\1........
<br /> Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application
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