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ELECTRICAL. fli ,,' RMIT & FIRE ALAR [ P MIT APPLICATION <br /> CITY OF EUI=RETT PERMIT SERVICES <br /> 3200 CEDAR STREET„ EVERETT,WA 98201 <br /> (P)425-257-881.0 I FAX 425=257-8857 I( )everetteps@everettvva.gov I www:everettwa.g€vipermits <br /> PROJECT SITE'INFORMATION <br /> PROJECT ADDRESS: 7. 0 /,,.t ,,t, /it <br /> PROJECT TYPE: 0 NEW.CONSTRUCTION 0 ADDITION LI TENANT IMPROVMENT 0 REMODEL. <br /> BUILDING USE: OSFR 0 TOWNHOUSE 0 DUPLEX 0 ADO 0 MULTI-FAMILY-#OF UNITS 0 COMMERCIAL. <br /> BUILDING AREA: sq t <br /> ELECTRICAL APPLICATION INFORMATION, <br /> CONTRACT PRICE OF WORK:$ &CO*(3(Q ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? e NO 0 YES #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 /> DESCRIPTI"0N OF WORK A CODE C1'TMPUUAN <br /> DESCRIPTION OFINORK a° ..vt. = u .vtrvit ,,h , <br /> 'IS THIS l'ERI IT EDUCATION,INSITUTIONAL,HEALTH ANrIOR PERSONAL CARE FACILITIES: V'• NO 0 YES—See Below&Pg.2 <br /> 0 By checking this box,I ant;`stating that I have read and understand all Of WAG'296=468,400,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 riot <br /> See Page 2 require Plan Review. <br /> ARE YOU AN t?WNER'fPERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 72 NO OYES-See Below Si.Pg.3 <br /> `"`- Pursuant to RCW 19,28.261,property owners and leaseholders cannot perforin electrical work on buildings for rent,sale,or lease without <br /> the proper electrical licensing°arid 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: piattill TENANT BUSINESS NAME Of Commercials <br /> OWNER MAILING ADDRESS: STREET ... <br /> CITY STATE ZIP <br /> OWNER PHONE OWNER EMAIL <br /> - <br /> ONTRACTOf NAME::- .rill r` .. r'i <br /> //� lII <br /> CONTRACTOR ADDRE .sSS: ns f tt '' ,41".41. :..._" IPO g D <br /> cry 40/4/4/000), STATE14.44 STIP 9F75 ,#„:4. <br /> CONTRACTOR PHONE:2Dff 7firiciCONTRACTOR"EMAIL: ,r ' jt40 ,0/14,,,,L700/44, .. 4,/,( rc.,p it <.: <br /> CONTRACTOR LIC.#(REQUIRED).j,,, (,)�+IA.4 i f CITY OF EVERETT USINESS LIC.#(REQUIRES): <br /> PRIMAR.Y"CONTACT: 0OWNER ONTRA0TOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> s Y t e> CONTACT EMAIL: I,ai A <br /> AGREEME 7 I hemby certify that 1 have read and examinertthis application ark(kzwthe same to be eue and correct .All provisions of laws and onlicrances <br /> governing this type of work will be completed whether specifred herein ornof. The granting of a penrr#does not presume to give authonlyto violate or cancel the <br /> provisions of any state orlocai taw regulating construction or the performance of construction. That lam authorized by the ownervofth s property to perform the <br /> work for which application is made and i-comply With The State CohtreStor's`Law 18.27 RCS/and 298,200 WAC. <br /> City of Everett ficial use Only <br /> PERMIT <br /> . ., : . sized Agent Signature *ate (Revised 11/6/2018) Paget-Application <br />