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• <br /> ELECTRICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASH a�To., (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov1 vw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 32/1 i fori AA< BUILDING AREA: sq ft <br /> PROJECT TYPE: NEW CONSTRUCTION ❑ADDITION `i 7 ENANT IMPROVMENT E REMODEL <br /> BUILDING USE: E SFR n TOWNHOUSE ❑ DUPLEX E ADU MULTI-FAMILY-m OF UNITS: COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ g,pOQ 5: ASSOCIATED BUILDING PERMIT#(f apelicablc): <br /> DESCRIBE SCOPE OF WORK: Fi)ren, %Jo Jow (/o7fL 'e CO,t,Tro( tJiIYri77 it;r (ter': t:T <br /> . ,�" sxs-7htns '7f�,-.r, 7 73 : Q,r)c On.e At-c-4�44o }goo�.r10 t/i.. ?' <br /> . r or /a_W ,L v.(..r�. <br /> THiS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ft NO ❑YES-Select Scope:❑Service ❑ Feeder ❑Circuits-#: E Complete Re-wire <br /> LOW VOLTAGE WORK? ElNO Al YES-#of Devices: ee <br /> SELECT SCOPE'REQUIRED;. ❑ Data ❑Intercom ,�W Thermostat ❑Audio ❑Secure Access ❑ Security System <br /> L� 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 and installation approval. <br /> ❑Other(L'st All): <br /> CODE COMPLIANCE <br /> iS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: -El NO El YES-See Below&Pg.2 <br /> By checking this box. I arn scaring 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 ail 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 UCENSURE:,�tJNO EYES-See Below&Pg.3 <br /> fl 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 /> Sce page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing!certifiicaticn requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: -4)r0a_P(.u,au `q- (`( �/-�- TENANT BUSINESS NAME(If Commercial): �j ,, •r✓.,t..7S <br /> j � b_GLi7 i <br /> OWNER MAILING ADDRESS: STREET AO /O 's /%� � T, �j Q/ / <br /> CCflY e.21 1(/✓L STATE k4 . Z' 2(G d0`l <br /> OWNER PHONE: 4/ZS'c/751" J 3 OWNER EMAIL: d. ace, CO"7-. <br /> CONTRACTOR NAME: 6-OG4nd 14:0/75/17 a ft07 �O/C �! <br /> CONTRACTOR ADDRESS: STREET S2 6 a ri #_A <br /> STATE �(/ SW 37S <br /> CONTRACTOR PHONE:pS3'STS--, SO CONTRACTOR EMAIL: ZA,4ri,'7 6'D A-6¢z,4 , G <br /> CONTRACTOR LIC, #(REQUIRED): cSoc,Ni//AO( 68/i) CITY OF EVERETT BUSINESS LIC.#(REQUIRED;: n 46-ci b <br /> PRIMARY CONTACT: EOWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME; Vau‘c p k CONTACT PHONE: as '_ 7 7 s—` 7VC <br /> 2 3- 074:44 CONTACT EMAIL: e424,rW /4 T,-' a��„ <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ali provisions o.laws and ordinances governing this <br /> 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 provisions of any other state or <br /> local law regulating construction or the performance of construction. That f am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with t ate Contractors Law 18 7 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT„ <br /> 7/09 <br /> Owner/Authorized Argent Signature Date (Revised 1/11/2S 19: Page 1-Application <br />