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r <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> ,Illz•z---_ ,-. CITY OF EVERETT PERMIT SERVICES <br /> -00,111wi, 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:� .x �� y C\ <br /> r, <br /> PROJECT TYPE: fill NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 1 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: �f980 sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ / 5f(90O ASSOCIATED- BUILDING PERMIT#(if applicable): t1 1 l i DID <br /> IS THIS LOW VOLTAGE WORK? 0 NO YES-#OF DEVICES: 4 <br /> IS THIS A FIRE ALARM PERMIT? lErNO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: -Tato,I tv r i`r!, For r1€kAi c 0 s` rvc`t i'On <br /> THIS SECTION APPLI TO ALL EDUC• ON,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> By chef in.this box, I a,.statin. that I have read a • . . stand all of WAC 296-46B-900,selected the specific reason on page 2 <br /> �I • is appli`.tion -e next page AND Pla '-view is N I eq sired because I meet all of the following sub sections that do not <br /> .e- •age 2 require Plan Review. <br /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without <br /> 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: TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 13 l S k1 P I er-'rka( C o h'tra C`1y,'SCJ C1✓ICi ole 51'5, ki <br /> CONTRACTOR ADDRESS: STREET 9.,:)..._0/ Cedar R0 �/ <br /> CITY LIke S4-.evimS STATE WA. ZIP 9 s. <br /> CONTRACTOR PHONE: y 5- -7 6O Q$CONTRACTORIIIIEMAIL: 2 t u e se(ect o 1 V c_ 9 Jv1q�(.coin <br /> CONTRACTOR LIC.#(REQUIRED) CG BLUIC 5 EC13`).0$ CITY OF EVERETT B SINESS LIC.#(REQUIRED):OS 66(73 <br /> PRIMARY CONTACT: IX.OWNER 0 CONTRACTOR 0 OTHER(Please Specify) / --hb O/'1 <br /> CONTACT NAME: CONTACT PHONE: ±—d' 14 -7 b0 'c, <br /> ViNi an Ke (ler CONTACT EMAIL:RI ue S Y P l't4rf N vents Mtii'/.cetil <br /> AGREEMENT.:I hereby certify that I 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 /> i►-- �"�- /'/ — — 1 , � Q U1L <br /> Owner•uthorized Agent Signature Date (Revised 10/30/2018) (Page 1 of 3 <br />