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! I <br /> , 4 <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> . „.A#005,— _____ _ _ _ <br /> .__-CIT OI'EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> sitigi <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa,gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> Ds D 14j6-1-1k Ne -?kms <br /> . . , <br /> PROJECT TYPE: ® NEW CONSTRUCTION %ADDITION 0 TENANT IMPROVMENT ®REMODEL L,{{ <br /> BUILDING USE: 0 SFR El TOWNHOUSE El DUPLEX El ADU ®MULTI-FAMILY-#OF UNITS: JG`�.>MOMMEROIAL <br /> BUILDING AREA: sq ft <br /> . .............. . . .. <br /> • <br /> ELECTRICAL APPLICATION INFORMATION • <br /> CONTRACT PRICE OF WORK:$ LAI CQ ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? ®NO YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? El NO PI YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: . .-i.0 ,) 1ee(V\ i-j1v, CitiCACAACt 0_0"N CAIN c , . <br /> 1 it . <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL HEALTH AND/OR PERSONAL CA E FACILITIES: pj NO El YES--See Below&Pg.2 <br /> pi. <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:fNO 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: TENANT BUSINESS NAME(If Commercial):.A\I leo \ <br /> OWNER MAILING ADDRESS: STREET(,.Q 5010 K i 1\ Oje,.eik tiJL - . <br /> CRY e STATE w'k ZIP CO-f2(„)3 <br /> OWNER PHONE —12,V6 I0WNER EMAiL:Y`(1 (�,�t WTiW.v�(' ite.e i)5V\ <br /> . Q - <br /> CONTRACTOR NAME: UCAV-C,VeL1A, 6P.LlkYl.-kMi b 1' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY l STATE \N\ 6 zip C{ I <br /> CONTRACTOR PHONECat o(pik-3 +0 CONTRACTOR EMAIL:(RC IG kJrc�,�(�,(.1:x�—Ac/A1(\ -C O 1 <br /> CONTRACTOR LIC.#(REQUIRED): 7, ,Z CITY OF EVERETT BUSINESS LI (REQUIRED): Lkd <br /> PRIMARY CONTACT: 0 OWNER ` 1 CONTRACTOOR ❑OTHER(Please Specify) <br /> CONTACT NAME: '` CONTACT PHONE:tots) ( 9"T -3.c -*Le;�lk- ,`(� `� �� CONTACT EMAIL: lcolkutZ`.0 `Cf�t`C10Yv3p t( CSD <br /> AGREEMENT:!hereby certify their!he read and examined this application and know the same to a true and correct. All provisions of laws and or nances <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 /> ` <br /> •wner ,uthoriz.%AgePI'...% €gnature Date (Revised 11/5/2018) (Page llcation <br /> j CSI" <br />