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<br /> �� r c ELECTRICAL PERMIT APPLICATION 't
<br /> r •.^y EVERETT
<br /> cl fY OfETVERE r PERMIT SERVICES
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<br /> CEDAR STR('f'f.EVERETT,WA 98701I ;'
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<br /> } PROecY SIT INFORMATION •
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<br /> PROJECT ADDRESS -I( :)LI 140' t 4Ut,,,__ BUILDING AREA _ •sq ft
<br /> eta,. 3 I PROJECT TYPE. < I NEW LO' IRUt;Tll1N I..1 AUG(PION ..j.4I F El NT IMPROVMENT 1(,„I RPtvIODEL.
<br /> M.:WI BUILDING USE: X SFR FE TOWNHOUSE. 1-1 DUPLEX LI ADU ii Mlm C1-FAMILY #OF UNITS .. ... El COMHGRCIO � b S
<br /> •I a • ^ ., 1P-:.' ",:i::;•,.', ' �E *R1, ' I.APPLICATION 1.,^FO,•MAa s,Il#,r DES, `" " ° a ..s,1`i, C ._3
<br /> CONTRACT PRICE OF WORK:$ t:3 00.' ASSOCIATED BUILDING PERMIT#(if applicable'):
<br /> :,ItiiiiiDESCRIBE SCOPE OF WORK: 4 t LI ,-L4 tF .t,LA.e 4,. i,e,..},e...... .. . •k' ' .D „AC
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<br /> tax s.^ THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> •:'," LINE VOLTAGE WORK? r 1 NO Int YES-Select Scope.H Service n Feeder Circuits#.... I._i Complete Re-wire
<br /> LOW VOLTAGE WORK? NO r1 YES-#of Devices: ✓✓✓������
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<br /> SELECT SCOPE(REQUIRED).11 Date 71 Intercom 7 Thermostat ❑Audio ri Secure Access 1 Security System
<br /> _1 Fire Alarm-Installations under this permit only include electrical wiring rough-an of the system.An additional
<br /> ' •; Fire Alarm Permit is required for review of device location and installation approval.
<br /> > ❑Other(List All): QQ_ _...._
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<br /> �'. -,CODE MPI141AN„,.E r k*v %, •,41.,,:,,,,
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ! NO ... YES--See Below&Pg.2
<br /> t J j By checking this box,I am stating that I have read and understand all of WAC 296-468-900,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 /> s • See Page:? repo>re Plan Review
<br /> f i ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:►r NO ;__LYES-See Below&Pg.3
<br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> t 1 without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and
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<br /> See page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from thislicensing/certification requirement. •
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<br /> OWNER NAME: tti ., i -1' TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STI2'F T Li O 2 i s 1^' A• . _
<br /> CiTv Lf'"„11F+.ce..44 - ursee ", ZIP L"-t f- v Ll 1, .
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 1.)C3tO-Z.- E(e c-1-f,t( x`v i S .rs t i t
<br /> CONTRACTOR ADDRESS: sTROLr (y2.301. t"'\ : t O? •'1 `k -a.. t"
<br /> CONTRACTOR PHONE:t Z-S'"`2- 2 I--?, 01 CONTRACTOR EMAIL: 0 o1c),7 t,e,t..'-}'("I(., ". 9 Vt>r''tt tLOCe\
<br /> CONTRACTOR LIC,#(I/FOt1IRED): El.. 0 AV-4,. t'S k..1-2.415,1-• CITY OF EVERETT BUSINESS LIC.#(REQUIRED): l i}c(a
<br /> PRIMARY CONTACT r.:OWNl R F CONTRACTOR [__]OTHER(Please Specify)___ _______ __W _...___. ._.____._,
<br /> CONTACT NAME: CONTACT PHONE: 11 c - , , 1-i o
<br /> c fJi' - tq.1/4,4 2..f%V t G1,"" CONTACT EMAIL: ,_. L d (v Al "1 t L v,rt a fir,
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<br /> AGREEMt-torr I hereby rerrfty that 1 nava read and erotOuritidTis application and know the earn°to be true and cr>rrett.7tit pxuviskana o taws fled.."micas governing this
<br /> type of work wilt be completed whether specified harem or not, Me glatttrng of a parrrst tinea trot prosarae to gi.e authority to ooaare or Carmel The provisrorts of any other shite or
<br /> local.law regulating ronatttuction air fart pertnrrliinr:r1 of co+astroction, that I am authorised by the tss uer of Mkt prepttrly to.perr:sari the war*train which appticatio n is made and a
<br /> comply with the Clara Contracteta tae 1(1,21 RCW and 296,20()WAG. Cl of Everett Official Use On!:
<br /> PERMIT#`.
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<br /> Owner/Authorized Agent Sigrl tura ,ito , ekrisedII)(I; f+,) Page-Application.,
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