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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> 477CITY 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/perrnits <br /> PROJECT SITE.INPORMATION. ,; ::.. . . `. <br /> PROJECT ADDRESS: i 16.2-7 4 E Yp oc:.4- P....A . tr'e,(4-44 f 'i.'4 el 6 Lo <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ,TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: El SFR ❑TOWNHOUSE ❑DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: jEj COMMERCIAL <br /> BUILDING AREA: 2 -X5 sq ft <br /> ELECTRICAL APPL""ICATION:;INPORMATION ; •<; : . ': :,° .:. <br /> CONTRACT PRICE OF WORK:$ 7000 ;C ASSOCIATED BUILDING PERMIT#(If applicable): <br /> 1S THIS LOW VOLTAGE WORK? El NO NO YES-#OF DEVICES: 2.3 <br /> IS THIS A FIRE ALARM PERMIT? ❑NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTIO &:_ <br /> .... ..........:.:::>::...,...............,,.......:.:...:.:.: N O WORK <br /> :::::.::.:::..:..:::::� .::...:..::.: :.:,. ::...::::�:...:...: .. ...... ... N' CODE:. OM :LIANCE :,:, = <:>.:::: ;.•::: :_: ::.; ::;; : ::;:::;.::::.:,.::.::::: <br /> DESCRIPTION OF WORK: u t I 2.0 -.,v, ,I, CAT.( c.a. e s , •e'e 9'iLe rte;X, e• -tiS4/ es4( i <br /> -A6,„t . <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: j4 NO ❑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:,JNO 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.8y 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 /> `: CONTAOT INFORMATION <br /> OWNER NAME: 5 v•t(ty'Z.,c41 44:<::,tle.t'l TENANT BUSINESS NAME(If Commercial): g-'v e.•tretrx:-€.A. ::C 'lkr.: <br /> OWNER MAILING ADDRESS: STREET ¶( ie.77 /t'c”i?C;' ' J <br /> CITY i-VQ e-. jr STATELAJA ZIP f',}e 2 (. '. <br /> OWNER PHONE: OWNER EMAIL: / 2l G <br /> CONTRACTOR NAME: F i c=lkii 5 <br /> CONTRACTOR ADDRESS: STREET ., pp56' ii1itk.A15,'tr Dr, F t7 (g <br /> CITY Tie 9LCtv•F (F} STATE ijY` g1 r ZIP <br /> CONTRACTOR PHONE: r 3"1.43"-1.--70 i CONTRACTOR EMAIL: r-i,c4. TVILOke"t,s L•'\irr6cAct rt t4.1 <br /> CONTRACTOR LIC.#(REQUIRED): -c3 Cit) C.I. Cia.1 Q a CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 052.7 e(- <br /> PRIMARY CONTACT: ❑OWNER 4 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2(_::,--.:-5 " (c.. I-7 <br /> -0 l <br /> j-i-c'rS, ifK.{/ t .k`, C,+d\ CONTACT EMAIL: bce:ket.: (Y1c.phe8 ) --.(; 1;elk 1 f'It'(./,. 01 <br /> AGREEMENT:1 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 t 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 /> I PERMIT <br /> .----7 .---. E lg O I— 0 0" <br /> ....›, 15 • <br /> .Owner/ ze( Agent Signature Date (Revised 11/5/2018) Page 1-Application <br />