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4 <br /> ELECTRICAL PIFMIT & FIRE ALARM PMIT APPLICATION <br /> "IIP.%V/.----ACITY OF EVERETT PERMIT SER S <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: d JQi 6E EVQ t mriii waw ) 4,,,i-Fe_ t. <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 121COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 300 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? 'NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: Appii <br /> o L fl fi rat re,-yn I.+ -Fn A an, i JJze1+ri* a Q J13A �//' <br /> 17C) QX i S-h'nCl . n e i'1i,eui-� <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: , NO ❑YES--See Below&Pg.2 <br /> El <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: NO OYES-See Below&Pg.3 <br /> DPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buil rags for rent,sale,or lease without <br /> u 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: f/ill S 1.04-j '1A 19-rnu)n,TENANT BUSINESS NAME(If Commercial): 12-)R PO 60 D,u,+( cupp <br /> OWNER MAILING ADDRESS: STREET ��� `� ' r <br /> I �E �i)ItllJl.ti� Mail �,(/�y � G <br /> CITY EV 0 ,QJ-E; a STATE UM ZIP <br /> OWNER PHONE: -- 2 Q* t 75- OWNER EMAIL: <br /> CONTRACTOR NAME: 51ickoin 6ppn('li <br /> CONTRACTOR ADDRESS: STREET i' , 02,5' ) -nut ,6F <br /> CITY 10 STATE Wil ZIP gg'o&, <br /> CONTRACTOR PHONE: ..)- ,6 .14-.!' 0.2.4 ONTRACTOR AIL: eci001 • earn <br /> CONTRACTOR LIC.#(REQUIRED): 5►EN C6 M (103 L C1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5 x]43,6 <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR gOT ER(Please Specify) 1-14071;2d - sJi- <br /> CONTACT NAME: CONTACT ONE: 0206 6 E ei G CI J <br /> —r311)3 1-2 CON T EMAIL: Sevlgn lie @ oamai I • com <br /> AGREEMENT:I hereby certify that/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 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 /> Lexiothorized ent Signature ate (Revised 11/5/2018) Page 1-Application <br />