5021 W HIGHLAND RD 2019-11-14 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES i#11111PI" -":41 vic// 4.4, 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-267-8810 I FAX 425-257-8857 (E)everetteps@everettwagov www.eyetettwagoviperrnits 1/47, -1/4 - 0 ''"040440;,,WWRORWIMPOTWWW•Ow41”'' 114'704M:WWFWRIIVW=IX:, PROJECT ADDRESS OZ ¼ VCLifict.s.,\,0 4-0 PROJECT TYPE: 0 NEW CONSTRUCTION Ej ADDITION 0 ENANT IMPROVMENT "EMODEL BUILDING USE: { FR 0 TOWNHOUSE 0 DUPLEX 0 DU OVIULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: sq ftiiririri 1 = . e ;< '** tzwenr-- EEL ; CONTRACT PRICE OF WORK:$ C)C> ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? LZI NO 0 ES #OF DEVICES: IS THIS A FIRE ALARM PERMIT? MI NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK: nil 4 k:>--r tA.J. THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 01 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 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. :ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: taPursuant to RCW 19.28.261,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,I am stating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. ttK IffOt OWNER NAME: 1E-12 (Z„ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 50 Z. L ciry EVEaerr STATE Lit3 ZIP CA Z.0 3 OWNER PHONE: 2.eb '%**53 CL ?_ OWNER EMAIL: CC k("- e, C- CONTRACTOR NAME: A KJ' 1\A E L —TV2 k Cr, CONTRACTOR ADDRESS: STREET 1010 112- N°' '43 c,Ty R,S.I3-("N 01"4 STATE WA pO5 1 CONTRACTOR PHONE: Lk 11-S Vbik'-k‘q 5 CONTRACTOR EMAIL: )•\0 2 EVN)C) P4act-ws.(,, (0i1/411 CONTRACTOR LIC.#(REOUIRED): t MO-1,- OS%L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0 55 q sq PRIMARY CONTACT: *VVNER ikONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 1AI.:5 S 6 AJCQ CONTACT EMAIL: Api INN CZ,142 0„ke‘ AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be five and correct. All provisions of laws and ordinances 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 provisions of any other state or local law regu ing construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work tor which a.• .n is made and I corn 1 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 3.0504111k kii12-0. 12,0 \q/ . . Owner/Authorized Agent Signature Date (Revised 16130/2018) Page 1 of 3