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<br /> ELECTRICAL PERMIT APPLICATION
<br /> EV C R E T T CITY OF EVERETT PERMFr SERVICES
<br /> G fi 32�D CEDAR STREET,EVERETT,WA 98201
<br /> wASHINGTON (P)425-25T-8810 1 FAX 1(E)everettepsGeverethva.gov I www.everettwagov/permas
<br /> gov/penis
<br /> 6.-Vi f ?r- z% _ ' n 4JE AIT JNE OR IIQN _w IfeS,, `a,� Thee ,
<br /> PROJECT ADDRESS:a ( gcte c.1-4 Qs-r BUILDING AREA: `�W-f sq ft
<br /> PROJECT TYPE: P$I EW CONSTRUCTION QADDmOM ❑�TE�NANTIMPROVMENT ❑REMODEL
<br /> BUILDING USE: ElSFR 0 TOWNHOUSE El DUPLEX -21& 0 MULTI-FAMILY #OF UNITS:- 0 COMMERCIAL
<br /> f :}V r L! ..ELECT ;A '',. .. AT0.A►_' [O NEOR T 11bSc11FSCR1-P OI A t'1N°,z._ `+-�x ._" t7t
<br /> ONTRACT PRICE OF WORK:$ _;COO ASSOCIATED BUILDING PERMIT#.(if applicable) e i q off Op 7.
<br /> DESCRIBE SCOPE OF WORK'.
<br /> `&OI1 eilltfelaL t1{2:0 64tOkt-f ML.vi (AA) roil_ flpi tT -JGec4,
<br /> OoNi ova-`t om o4 +J -re:coca l%E1riirt -tio To E.,,,x37 Rc"yw -r.)e:
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL.THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO LeLOi.YES-Select-Scope:0 Service D Feeder 0.Circults-#; eSompiete Re-wire
<br /> LOW VOLTAGE WORK? El NO -❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED);0 Data ❑Intercom 0 Thermostat CI Audio O Secure Access O 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 is required for review of device location andinattillabon approval,
<br /> ..." 0Other:(list All):
<br /> ` x tfrM.ri " Aai. -+- 42'Vi B acomp i! im ; ti:,4. .x1,7. .veq Ypz..K h t k 2 '
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH MINOR PERSONAL CARE FACILRIES: El NO -U YES--See Below&Pg.2
<br /> flBy cheddng this box,I am stating that I have read and understand all of WAC 298-46B-900,selected.thespecific reason on page 2
<br /> I of this application(see next page),.AND Plan Review is NOT required because I meet all of the following sub sect! that do not
<br /> See Page 2 r 're Plan Review.
<br /> AREYBU WNER PERFORMING WORK AS.THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO YES-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 /> 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 /> S.-_. .:--.�. ,�a�'�.,;�...a.--rv`mhs.�:y,:, .b'`�,., �' ,uits'�L,e.at.`1. ��✓A�'�.:*,:�PR4:,: I a.ar;.�5�"�," _ yni ,'"-: a�„�'r.-a,..P' '
<br /> ' 'dBv �va^�w y31* Nxt
<br /> OWNER NAME: LUNN - afSt?ECCa J TENANT BUSINESS NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: STREET (0309VU, %EECk4 Sl" c�fr }j�
<br /> cily E ` 4
<br /> tL. [. : STATE V�'T)�J�I 78 is©'243
<br /> OWNER.PHONE: .. OWNER EMAIL:;
<br /> -,
<br /> CONTRACTOR NAME: .
<br /> CONTRACTOR ADDRESS: -slew ..
<br /> CnY STATE ZIP:
<br /> CONTRACTOR PHONE : CONTRACTOR EMAIL:
<br /> CONTRACTOR LLC.#(REQUIRED): 1CITY OF EVERETT BUSINESS Lie.#(REQUIRED):
<br /> PRIMARY CONTACT: DOWNER. DCONTRACTOR ,OTHER(Please Specify) S n{a.1�t cc 0,tnt( 1)...
<br /> CO--N��T((ACT NAME: y� CONTACT PHONE: 91,3 3 5 0- if". f(0 1.
<br /> Z,JOtt4 rr'}2,-, lCA`a CONTACT EMAIL 30An.0 e.cbt-53'mn(.t$.(Alrl;rt .C,arvt
<br /> AGREEMENT:!hereby seedy' that 1aave reed endexamined this application eel knew tee same to be true and correct AIIprovisions of lag and aUrnaness governing this
<br /> type of work willbe completed whether spec ed herein or not The gianm,g ofepemlit does not presume to give authority h violate orcence/the pm-Weans of any others/ate or
<br /> locarlawregufatIN construction ortheperfwmanceofconsfnction. That l am authorsedbythe owner of this property to perform thework for welsh appecebbn Is made and!
<br /> ccmply with the Slate Contract)4ors Law 1827RCWand296200 WAC.
<br /> City of Everett Official Use Only
<br /> itjPERMIT#:
<br /> r
<br /> / 19
<br /> Ow �- Agent Signature Date (Revised VII 019) .:...Paget-Application
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