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ELECTRICAL IlikkMIT & FIRE ALARM P=-EMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OJETT3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 10(1 (P--11 t r)I. — t;�� . f r" U `�_'-cLTh <br /> PROJECT TYPETtt NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE -DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ S (ZS ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? 0 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: (X) ` ° r l Q\,LJ 4(7)4 <br /> C frip <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALT ND/OR PERSONAL CARE FACILITIES: 0 NO 0 YES--See Below&Pg. 2 <br /> ❑ 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 <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: ONO OYES-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 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 /> C <br /> CONTACT INFORMATION NFORMATION <br /> TENANT BUSINESS NAME <br /> (If Commercial):OWNER NAME: // ICSe_ <br /> OWNER MAILING ADDRES : STREET J`Lft &v <br /> int _\ <br /> CITY ,�� ,� STATE Lino . ZIP •b„ , <br /> OWNER PHONE: OWNERMAIt_: <br /> ` -ko'� 1 f <br /> CONTRACTOR NAME: �ru —�O <br /> CONTRACTOR ADDRESS: STREET tLI'1 S) �> V,e. S U `*. ( 0 J — 1 SI <br /> rCITY�1 0'`r> �)� STA <br /> CONTRACTOR PHONY:l 11). V— l CONTRACTOR EMAIL: l._) JipA if • r 4 C .,/� . <br /> CONTRACTOR LIC.#(REQUIRE � �.iL I $ <br /> 0CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ,))��r I <br /> PRIMARY CONTACT: ❑OWNER --1TCONTRACTOR 0 OTHEF Please Specify) <br /> CONTACT NAME: J ± <br /> CONTACT PHONIC LA <br /> ,) Gi . QL{)9 <br /> S7t ( 1 1 iZ€ ( <br /> CONTACT EMAIL: cx) I c �'1 ( ((AV- <br /> T.Ihereby <br /> (AV- <br /> AGREEMENT: h ereby certify that 1 have read and examined this application and know the same to be true and co ect. 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 I. -.ulating 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• d 1 co .,ly with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,10 <br /> S lii <br /> aC,o rpt C� <br /> Owner/Authori ed Agent Signature Date (Revised 11/5/2018) Page 1-Application <br />