Laserfiche WebLink
ir <br /> ELECTRICAL law FIRE ALARM PIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> «,l_ 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 6 23 \oi 1V� <br /> � E4?),(6. W* gg2cJ1 <br /> PROJECT TYPE: 161 NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU al MULTI-FAMILY-#OF UNITS: 3 0 COMMERCIAL <br /> BUILDING AREA: 21 6°C) sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ '6-WO ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? ® NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: N& SQf'J Avg W\YWY' <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ,<O 0 YES--See Below&Pg.2 <br /> ElBy 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 <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 /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: riNO OYES-See Below&Pg.3 <br /> F-1 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buil in for rent,sale,or lease without <br /> L J 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: 5\7y(13Q' Sa\I V TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(023 j} law 6fizve1 \NI\ N201 <br /> cm( STATE <br /> ,, ilk ZIP KVA <br /> OWNER PHONE: $ � <br /> � 'cgO2U OWNER EMAIL: 5Y�'n kaAnvi/^'/`YwitIvu;k,ccw <br /> CONTRACTOR NAME: 0 MP%) Aga�h LI.C., J <br /> CONTRACTOR ADDRESS: STREETT1 � ry <br /> � 111�,75 S T SIi+1 <br /> .,2 20U <br /> CITY EJJQ.Y1Z STATEV* ZIP CYZ 2,.C),5 <br /> CONTRACTOR PHONE(egC014S5-'$333 CONTRACTOR EMAIL: J )ONr CO(r; IA yVLANggo4w.CA11v\ <br /> CONTRACTOR LIC.#(REQUIRED): AIINEN A Z 6 7 Kti CITY OF EVERETT BUSINESS LIC.`#(REQUIRED): 5177 rj <br /> PRIMARY CONTACT: 0 OWNER ,12(CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:C 4 26, c (g_70% <br /> —r-odr Gotu70vtd CONTACT EMAIL: roof-G ® A 11 hit O&)r 'QOM <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 /> IWZO1q \C.° ( ~ O( <br /> _. .. <br /> Owner/ horized Agent Signature Date (Revised 11/5/2018) <br />