620 112TH ST SE SPACE 208 2020-02-25

ELECTRICAL IRMIT & FIRE ALARM PAMIT APPLICATION epopz. 0,/__./.,_A CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6)0 II 2711 sT 2 Og PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: sq ft • ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ moo ASSOCIATED BUILDIN PERMIT#(if applicable): ,5/e j0--C'.26.4 IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? la NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: kTet)k I ir•16 U p NaLt) f( Vr f} ken 4 M IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO 0 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: ONO OYES-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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: /4 f fG¢j-f - V fail- TENANT BUSINESS NAME(If Commercial): Mail, / oMe— OWNER MAILING ADDRESS: STREET/ 72J74- (p c :/ t?4 SST, �UITj / 3 [�j cITY /J E (<5Ll t) STATE W ZIP /t4� OWNER PHONE: '/ZS"-°' AN- 7( r OWNER EMAIL: 0(26,k. (t� , CGS `' CONTRACTOR NAME: Tk o A&R Peg-Cr t2-1 cAL- S CONTRACTOR ADDRESS: STREET f'024 2 PtrC-i Pic A v C S CITY Tr v- ( STATE 1/1,),9- ZIP 964144- CONTRACTOR PHONE: 2S-3.-.020-3711 CONTRACTOR EMAIL: bAj(a it k,(Y PcEs; COM CONTRACTOR LIC.#(REQUIRED):fDfmits 933 0 1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Vr:10e 1 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR IX1 OTHER(Please Specify) 'Z LTT c-0tt: AI— CONTACT NAME: CONTACT PHONE: .-2E I— 62/) e-44 v && CONTACT EMAIL: , t( , f I •C°AGREEMENT::I hereby certify that!have read and examined this application and know the sam-)o be tr and correct.tJAII 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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only ftPERMIT.73 1147g `# OwnerlAuthorized Agent Signatur Date (Revised 11/5/2018))- Page 1-Application