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i 1 Mil uffin ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: '-//4' A /v t'P YI 6 CM!—,e 41 k�/ 962,-, BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION LI ADDITION aI TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ZISFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:" ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: f P v✓t e 0,{ (c,/ /'','`r IO d ;- 9 *,,/,,..: y -17ci w cv 44 j re )• 1 /1 _S•lel If Vt e ix) C o c€A fry?ei ,1 PC /( ,---r. S'f� ...(P foci a r.' /kms A C-- I THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO Y,21/YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: i 17 Complete Re-wire LOW VOLTAGE WORK? 111 NO l,,Q YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom "Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire rm Permit is required for review of device location and insta)lation approval. Other(List All): P-j .. ,i''AC, +/..- E c'e�c'irye(. -t,e' _Si,`'Iy Ct fci. ,' CODE COMPLIANCE / IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 17140 ❑YES--See Below&Pg.2 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO ❑YES-See Below&Pg.3 Pursuant 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACTINFORMATION OWNER NAME: uu j-6 v r fl.S TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET vfE"//4' AL..C J 6:1 /(} CITY L vA 'Pi