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Mar 1719 05:04a Bob Jack 15096746777 p.2
<br /> ELECTRICAL PE,*BAIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> . • FAX 425-2578857 l(E)everetteps@everettwa.gov I www.everetb-vagov/Permits
<br /> (P}425-257-8810 I ret everetMra.gov/perm�Ls
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<br /> PROJECT ADDRESS:G fa�Q� olI�</C C;/r�� y BUiLDIN AREA: sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION ®ADDITION TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: I:I SFR ®TOWNHOUSE .®DUPLEX El ADU El MULTI-FAMILY #OF UNITS: COMMERCIAL
<br /> ; is•,::' i:-C.;'i:'•r_.EIECTR C tig.APP1.ICA'71.91. .INFO .MATION DESCR0' ON
<br /> CONTRACT PRICE OF WORK:$ 4;31)/0 ASSOCIATED BUILDING PERMIT#(II applicable):
<br /> DESCRIBE SCOPE OF WORK: J $/—,4't( /ft)( 0/71-$41.e___ c1 'f't4'1 --
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<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? atIO 0 YES-Select Scope:El Service El Feeder ®Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? ®NO [, ES-#of Devices: SecuritySystem
<br /> SELECT SCOPE(REQUIRED):
<br /> ata El Intercom 0 Thermostat 0 Audio .El Secure Access Y
<br /> ®Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> El Other(List All): = s. - _ w, _....,_ _,
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<br /> :r;..• .Sw:,�::. :•.. .,._:::..�:.•,.....,�._ ...',J e YES--See Below&Pg.2
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO
<br /> ® By checking this box,I am stating that I have read and understand all of WAC 296-46B-900,se ected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required because I meet ail of the following sub sections that do not
<br /> See Page 2 require Plan Review. DYES-See
<br /> ARE YOU AN OWNER PERFORMING WORK ASTHE
<br /> COwners TRACT Riders cannotOUT perform electrical LLICENSURE:
<br /> on b lldi Os for rent,sale,or &Pg 3
<br /> with Pursuant tRC19.28.261,cal l property
<br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and
<br /> application exemption from this licensing/certification requirement.'
<br /> signed the AFFIDAVIT on page 3 of this a ion to receive an � •, . _ _
<br /> See Page 3 wry;: ' -•- �'�^
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<br /> OWNER NAME: 0 -e-yz4 TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAIUNG ADDRESS: STREET
<br /> STATE zip
<br /> CRY
<br /> OWNER PHONE:
<br /> TOWNER EMAIL: ..__...Y.
<br /> CONTRACTOR NAME: mi Si..r rt'lr\
<br /> , L7A) 1
<br /> CONTRACTOR ADDRESS: STREET 1/3 Li Atr1-, i-i-pc/c-/Ode
<br /> CITY - STATE 0' zip 62/7a172--
<br /> / CONTRACTOR EMAIL: /� -3".."44-4k 6 `j e� tZ
<br /> CONTRACTOR PHONE: fdlf�7J�f® � �/ �,S
<br /> (rj"e CITY OF EVERETT BUSINESS LIC.#(REQUIRED: .a 4 • __ ____ •.--
<br /> COM1tTRACTOR LIC.#(REQUIRED`: [> / -
<br /> PRIMARY CONTACT: 0 OWNER _ ,CONTRACTOR 0 OTHER(Please Specify) p
<br /> CONTACT NAME: CONTACT PHONE: 47 j .r47 3 -L
<br /> � � k CONTACT EMAIL: g j P '" SCA t.-E60
<br /> AG ENME �herebyt
<br /> f have read and examined this application and know the same to be true and authority Alt violatevisions of
<br /> laws
<br /> l the ordinances
<br /> c sof governing flits or
<br /> type of work wit Ibe-• plate. • ether specified herein or not. The granting of a permit does not presumegiveto to vthe whichpapplication n made and I
<br /> focal law regale' •construction 0 e performance of construction. That I am authorised by the owner of this propertyPworkci of for Everett application
<br /> Official Ups On
<br /> comply with t e Stare ConlracfarsL:w 1ti27Rv^Warid29&200 WAC. PERMIT#:
<br /> � Date (Revised 1/'t 1/2019)
<br /> Page 1 Applicatco
<br /> OwnorlA Sig 1� •
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