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ELECTRICAL PER-MIT APPLI;CATIt)N. <br /> p CITY OF EVEREPERMIT SERVICES <br /> V R E T T 3200 CEDAR STREET EVER€TT,WA 98201 <br /> WASHtotaTON SP)425-2574810 I FAX 425-2574857 I(E)everettepsl verettwa.gov j w± ,everetiwa govtpermits <br /> PROOCT SITE INFOMMATION <br /> PROJECT'ADDRESS: ,," _. . BAIT DING• -EAAe' sq ft <br /> • PROJECT TYPE 0:New CONSTRUCTION }ADDITIOi! TENANT IMPROVMENT REMODEL <br /> BUILDING,uSE; SFR 0.TOW.k - - , BUPLEX 0ADI! 0 MULTI-FAMILY-#OF UNITS_____ 0 COMMERCIAL <br /> • <br /> ELEC - L APPL A 8: INFORMATION &.DESCR PTI oN OF WORK <br /> CONTRACT PRICE OF W* •$ ASSOCIATED-BUILDING PERMIT#(if epplicable): <br /> DESCRIBE SCOPE OR ORK: t - .. ,' 'A , . U w ." .. • <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPL. <br /> LINE VOLTAGE WORK? 0 NO •0"YES-Select Scope:©Service. 0 Feeder 0 Clr"cuits f:. 0 Complete Rewire <br /> LOW VOLTAGE WORK? L!Nt7' YES-#of Deviciaee. 0 rpt <br /> SELECTSCOPE(REQUIRED):0 Data r..I Intercom; I_I ttllermostat Audio S•ecure Access t_I Securifyr System <br /> 0:Fire Alarm-Installations under this permit only include:electrical wiring rough4in:Of the system An additional <br /> Fire Alarm I errnit"is required'for revie nrof device Ideation and installation approval..; <br /> D Other(List All}_ .... <br /> IS THIS PERMIT•EDUCATION,INSTITUTIONAL,HEALTH ANDIOR PERSONAL,CARE FACILITIES: ra NO � YES- See Below"&Pg.2 <br /> By checking this box,I'am stating that I have read and understand;all of WAC 298.4a B=9OO 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 follow in'.sub sections that do not <br /> SeePage 2 'requite Flan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE C NO EYES-See Below&Pg.3 <br /> Pursuant to RCW 1.S.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,i am stating that I have completed and <br /> See-Page 3 'sighed the AFFIDAVIT on,page 3 of this application to receive an exemption from this licensing/certification requirement <br /> CONTACT INFORMATION <br /> OWNER NAME i' "a- .4 ;i, . e:;TENANT BUSINESS NAME f Commercial <br /> OWNER MAILING SFE mesa L� <br /> STATEzipl <br /> OWNER PHONE; TOWNER EIi AILY; <br /> CONTRACTOR NAME. LIGHTSMITH ELECTRIC, LLC <br /> CONTRACTOR ADDRESS•. sumer r 1.2061 124Th AVE NE <br /> I<IIII,ANi STATE tA: ,98034 <br /> CONTRACTOR PHONE-425-285-5552 coiNintikeioR EMAItL:OFFICE.LIGHTSMITH GMAIL.CO li <br /> CONTRACTOR Lie REQUIRED):UGHTEL.825RF" CITY OF.EVERETT BUSINESS LIC.#(REQUIRED):58579 <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR ROTI-[ER(Please Solidly) <br /> CONTACT NAMEe, CONTACT PHONE-425.323-5552 <br /> 1lE l E"R CONTACT cMAIL:JENNIFER.LIGHTSMITHtGMAIL.COM <br /> AG- mENn t hereby certify that!have"read and examined this application and know She same-to be tare and correct All provisions oftaws and ordinances governing is <br /> type of-work`will becompleted whether specified herein or not. ;The g'ranting,ofa permit does nut presume to give authority to Violate or cancel the provisions ofenY other state or <br /> focal law regulating construction•orthe performance of conattuetian. than amauthorized by the:owner ofthis`PloPertY to perform.the worn for.which application is made and <br /> oompy with the to Contractors`.aw,1 .27`RCWand 296200 t?ilA City of Everett Official Use Only <br /> PERIVIIT#k <br /> 1 L L�dib <br /> Ow' utho A . ..ignitors Date (Rev: 111!112019) Page#Agplic itior <br />