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0.111 --_ ,--ii ELECTRICAL PERMIT AP.ATION CITY OF EVERETT PERMIT SERVICES ___ 3200 CEDAR STREET,EVERETT,WA 98201 (P)425 257 8810 I FAX 425 257 8857 1(E)■■everetteps@evee�rettttwa gov I www.everettwa.gov/permits x" Z C tE,'�?5 \ -.F jrpROJTE SIT 4!W,l okk'r IO tM2 _ .. \.. :t. .1 .. Vv>.... PROJECT ADDRESS: n )l II`Z- f' trr 'BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION D TENANT IMPROVMENT Fli REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU Q MULTI-FAMILY #OF UNITS: ? 0 COMMERCIAL MinggigigiffEL'EPTRKAPAP ''LI TION ..�pny■,,,��R _ .yq,� �..... �..j}.lry�OP ..a,....< �N , �, ...yzyR.''�. ....r> �E ��lF i1��R� �'Y�#!�V�� IV' i/� �R�� ..'�`� t� 413 'G -. CONTRACT PRICE OF WORK:$ coJ �' 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: NEW tod A 1-4-‘' 5E FA)1 Cc CA,-) >fCre THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio .0 Secure Access 0 Security System 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. 0 Other(List All): e - -*.s t - T 'rvaa y -"' ., M i-. ' -z yr'Y /ODE COM a7 zg go `asR . S '" „c. `'_ -r.�`l r�"V� IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: g NO U 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:A1O DYES-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 applicationto receive an exemption from this licensing/certification requirement. _ z ¢ 3r gC MgCgttVtgaM` tgn uZ + vr - OWNER NAME: L.E€ Nil.)C p%IJ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET b t 3 3 //2,61<t- , (<\r SI-. N t"', 'W/ ) � ,L� (� CITY STA/. WO U t) STATE I) ZIP OWNER PHONE:91,5 goZ 52 501, OWNER EMAIL: CONTRACTOR NAME: SJ(`r`N\' C---L-C-C----c P ' ) NI( 1 CONTRACTOR ADDRESS: STREET�G\ Z 3- /� 'L 5-1- S /v r ' ^ �^+ ) CITY d`T.NN W UU STATE L IN ZIP .: l-t CONTRACTOR PHONE:9(I'S O S 5154)'CONTRACTOR EMAIL: NJ MM\ \ C�- S 1\ 'cam'N'''' CONTRACTOR LIC.#(REQUIRED): f C C\ - 006 \ CITY OF EVERETT BUSINESS LIC.#(REQUIRED•): 5 t '3 G PRIMARY CONTACT: DOWNER LICONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Li Qs' 26SS S 59 Lee ,.‘G CONTACT EMAIL: /,�\M tt"e 1 f\C�. cc r ,C.-,U AGREEMENT:I hereby certify t I have read and examined this application and know the same to be true and correct. All provisions'of laws and ordinances 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 provisions of any other state or local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the C r oforwEvhichapplicat Opic ati ion Use made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. tyPERMIT#: 11\l ---� , t E `'cl 03 --o( Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application