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4 <br /> ELECTRICAL FLRMIT & FIRE ALARM PMIT APPLICATION <br /> 4:77. CITY 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/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: F <br /> ett,(o £454.1 - <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION ENANT IMPROVMENT, 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU iJ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ .- ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? larit5 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: ' 'f r d_f 1'Zcce L d Rev/1G( <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I NO 0 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: O 'f OYES-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.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:peat �P4A ' , ��TE� <br /> TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I t5 41/44.0 <br /> 61(,x, Mid <br /> STATE . ZIP�g <br /> INTIIP ' <br /> OWNER /— Ilv!( OWNER EMAIL: <br /> CONTRACTOR NAME: ///J &(&1 'El s <br /> CONTRACTOR ADDRESS: STREETj�Q/'Z� � 4€ �C7'b <br /> '�t� CITY Q 1 STATE A �' ZIP �� - <br /> CONTRACTOF^F' PfC�E: c� 3 CONTRACTOR EMAIL: 70,4 Jrp <br /> CONTRACTOR LIC.#(REQUIRED),�f((. 4 (p`� CITY OF EVERETT�SS LIC.#(REQ; RED): <br /> SCS 222,.. <br /> PRIMARY CONTACT: 0 OWNER cCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zve -9-4E4 fze3 <br /> iza4, eon CONTACT EMAIL: ,�rrn d.. Me'.49014 <br /> AGREEMENT::I hereby certify-that ,�,5jf.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 applic- 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 /> vrtrar /0/2/9 E 01Z2 <br /> Owner/Authorized 4ent ' ur Date (Revised 11/5/2018) Page 1-Application <br />