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ELECTRICAL RMIT & FIRE ALARM PESIT APPLICATION CITY QF EVERETT PERMIT SERVICES ottiwif - 3200-CEDAR STREET,,-EVERETT,.WA 98201 (P)425-2574810 I FAX 425-257-8857 I(E)eve s.tteps. everettwa,gov I vx!ww.everettwa govipermits , PROJECT Sitt INFORMATION � �,,� e , PROJECT ADDRESS: "10 ItT ti &VU --clic.r+ q001,0'72 PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT `k:II REMODEL BUILDING USE: 4 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU ❑MULTI,-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: Ai' t 0 sq ft ELI CTRICA , PL ` e, .vz�y ' ;w CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT# fepplicabie): IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: IS THIS'A FIRE ALARM PERMIT? 0 NO ❑ YES.Plans required for review(Both Electrical and Fire Department Inspections are required) -404:;... 1. SCRNSION:OF WORT + 'w CODE COMP AN .,E DESCRIPTION OF WORK: MOCOttt tiq i riv' 3 '0 el C4 Odor- ri1 AW 1/110q1 'i i 47irAttaiNei Git/ti-CS IS THIS:PERMIT EDUCATION,INSITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: 0 NO 0 YES--,,See Below 8,Pg.2 DBy checking this box,llam:stating that.]have read and understand all of WAC 2964611-000,selected the specific reason on-page 2- of this applicatian.(see next page),AND Plan Review is NOT required because I rneet all of the following sub sections that do:not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS-THE CONTRACTOR WITHOUT ELECTRICAL.LICENSURE ONO OYES-See Below&:Pg:•8 fPursuant to RCW 19!28281 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,lam stating that I have completed and;signed the See Page3 AFFIDAVIT on page lot this application-to receive an exemption from this licensingtcertification requirement: f 3• CONTACT:.INFORMATION .,,-. ., , :. OWNER.NAME: 14 Y le otItex TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: mem ' 1 " Ct CITY vove-if STATE WA I'• .zip 1:02,0 ' OWNER PHONE: fl IOL OWNER EMAIL: I'1 I _ CONTRACTOR NAME: 111 OUSC cevir i C CONTRACTOR.ADDRESS: MEET (O' 0' trim Dr tit: env IC Ic€ 1/43 AO1S t- re.:wag WA 2 �C7143 (b CONTRACTOR PHONE 4.70-( d CONTRACTOR EMAIL 11tit 1e ml-rtmotif,( CONTRACTOR UC,*REQUIRED):al t UI ' ,, 02'I & ,'CITY OF.EVERETT BUSINESS LIC #(,REQUIRED): t4/-4 t 9 'PRIMARY:CONTACT: (DOWNER 40-CONTRACTOR 0 QTHER;(Please Specify) ,CONTACT NAME. CONTACT PHONE:A.2✓, t VV ft` #' _CONTACT EMAIL: iheyeI 't)t Cil wail .fAlo AGREEMENT:I hereby certifythat I have read and examined.this appl(cation.and know the same to be tree•and correct. All provisions of laws end ordinances governing this type-of work wilt be completed'whetherspecifred herein or not. The granting of a permit.does.not presume to give authority to violate or WOW&the provisions of any ether Mete.orledeNew__•, =<r..constwtrction:or the:perfoirnance o f construction. That t am euthol ed by'the owner:of this property to perionn the work for which application remade and l ply the State Contrsctors.t.aw 14,27 RCW and 296,200 WAG, City of Everett Official use Only PERMIT# A.11'#7 ' , / OtO 110 Owner' •diedAg: ,Sig ature Date (Revised 14/5018) Pape'I-Application Scanned with CamScanner