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t <br /> ELECTRICAL PERMIT & FIRE ALARM P MIT APPLICATION <br /> OlerrCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: l-7 8 3 V(RC .J(l\ AVE- <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT IN REMODEL <br /> BUILDING USE: RI SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ -2,.5- 0�— ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: ( Ng T AU., (per ,kms? I. A.DCE.we atl. ( yff...7eNCI'E-D 6AtiO. ` . <br /> Wi? 1- (- vc. ticr-lpcRGe.ou fia-bo#\ 4' (— 0 pvcr Le:30 (9au N <br /> C\.-(Ae- c.,m E)cs(st ANIQz. zoc, floAe� c.� b c,, t.vv .1 1.11 f-iovc6N(Ni <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> ❑ By checking this box, I am stating that I have read and understand all of WAC 296-468-900,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 /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <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. <br /> CONTACT INFORMATION <br /> OWNER NAME: (1,!C(-{NEL a c-C.,\!J C y TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 S fS(ioR{ S <br /> cm, l.V C R I STATE (1,542*. ZIP ? ?©f <br /> OWNER PHONE: 40,45 3 - c)(09-3 OWNER EMAIL: (utGC.,('N c rv..... e(RfC. @ G MMC—. <br /> CONTRACTOR NAME: (t-Q,cN( ( .E(g'C,t�'(G C`ty (00......CONTRACTOR ADDRESS: STREET( ,36(5 s-Eco,kr 4-(-- <br /> cm' EV RE-tr STATE tjOA ZIP zr e ...z.1 <br /> CONTRACTOR PHONE:425. 3 c -c5SCt3 CONTRACTOR EMAIL: SIAL{ <br /> CONTRACTOR LIC.#(REQUIRED):(tic(,(CJe_C t703 A/S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O 3%3,-f o <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /IQ 5 5c>e_ o 93 <br /> p'M(�. CONTACT EMAIL: _. ,(Nitt. <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 /> —,A� _r/�-.� 3- fa - 811 03- lei <br /> . <br /> Owner/Aut orized A.�!" Date (Revised 10/30/2018) Page 1 of 9 <br />