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PLECTRICAL PERMIT APPLII:ATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> 4rzir (P)425-257-8810 I FAX 425-257-8857 I(E)-everettepsrgeverettwa.gov I www.everettwa.gov/permits .
<br /> PrfreMIL AITN•71:DAVIty:' ,.,::-: IFROAEOPSITAINKRIVIATIOtenL;
<br /> 11.,_.14K. w marine vrevv Dr
<br /> PROJECT ADDRESS: I BUILDING AREA: sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION 0 ADDITION El TENANT IMPROVMENT it: REMODEL 420)1.f 5-1-Mid al
<br /> BUILDING USE: 0 SPR El TOWNHOUSE El DUPLEX CI ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> f.::,',:-;.;,,:::iAtK19.7ing4MR(PArlat:111%1WATI,ONA4FORMATIONA:I.JVICRIMON01eINORIVE:!.!:CE':Iitit *
<br /> CONTRACT PRICE OF WORK:$c9.1 taco ASSOCIATED BUILDING PERMIT#(if applicable): OD
<br /> VW icc(i1-. Lk
<br /> 1,
<br /> DESCRIBE SCOPE OF WORK: jelivq96:),_ Turk3 5.64401 ...., 1?;05gAgei Atlpujyte
<br /> Su. L tit e-, -,0y..- VI,I ,
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGEWORK? ...... NO ;2 YES-Select Scope:0 Service I!: ieeder Circuits4: CI Complete Re-wire tl4ereii3
<br /> LOW VOLTAGE WORK? E: NO 0 YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data El intercom 0 Thermostat 0 Audio 0,Secure Access El Security System
<br /> 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit isjequired for review of device location and installation approval.
<br /> Ptil Other(List All):HUYIf 5itt, GIx...1rical Y*4.10 r k
<br /> OPPEF.47.0,011BAIAX:::441101.10,111044:De :'iMPAii::::IC'A ORA,
<br /> Is THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: 0,2 NO 0 YES--See Below&Pg.2
<br /> 1-7 By checking this box,I am stating that I have,read and understand all of WAC 296468-900,selected the specific reason on page 2
<br /> " of this application(see next page),AND Plan Review is NOT required because t 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 t NNO0YES-See Below&Pg.3
<br /> NI\ Pursuantto ROA/1928.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> I
<br /> ' without the proper electrical licensing and.certification;or exemption.By checking this box, I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> OWNER NAME: ill, , ,,,+ TENANT BUSINESS.NAME(If Commercia): Vtrf 0'
<br /> T at r VtArT
<br /> OWNER MAILING ADDRESS: erne!. eAty) eecar lb (60W
<br /> .e ,v I I
<br /> CITY p re ,,._ STATE Vs/14 ZIP iNCIO I
<br /> OWNER PHONE: OWNER EMAIL:
<br /> . .
<br /> CONTRACTOR NAME: ACW(inCia'i PAVVer L L C
<br /> CONTRACTOR ADDRESS: ‘',, STREET pt) Roc 13-icst3
<br /> ay, in i 11f.rpek. srAre W A aP 61808 49,
<br /> CONTRACTOR PHONE:II at5-41-3,2,1DO CONTRACTOR.EMAIL: lbren f I_pile% &C A 01.corn
<br /> CONTRACTOR LIC.#(REQUIRED):A WAN pi_clei.... .CITY OF EVERETT BUSINESS LIC.CREouIREP): Lp5 5
<br /> .....,„ „.. _ ,....:, „.,,,.. ,
<br /> PRIMARY CONTACT: OWNER. , CONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: 1_0 ,D6r.reak.1 CONTACT PHONE: 14.9,i6..4 el_aa to 0
<br /> CONTACT EMAIL: 10 repo* Ct01. COM
<br /> AGREEMENT:I hereby certify that!have read and examined this application and know the same to be true arid correct, All provisions of laws end-ordinances governing this
<br /> type of work wit/be completed whether specified herein or not The granting of a permit does not presume to.give authority to violate or cancel the pm visions of any other state or
<br /> local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State ContractOra Law 18:27 RCVV and 296.200 WAG. City of Everett Official Use Only
<br /> PERMIT#:
<br /> Owner! thorized Agent Sigqature Date (Revised 1/1112019,1 Page 1-Application
<br />
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