|
40 •
<br /> `I ELECTRICAL zIVIIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> =')AR STREET,,EVERETT.WA.98201
<br /> WASHINGTON -3?10 I FAX 425-257 6S, everettep,Peverettwa.gov I www.everettwa.govipermits
<br /> I`"imirw., 3t•.' ' S; 11,+it�F"C MAT10I'
<br /> PROJECT ADDRESS: C - .,,ce jau8..DING AREA: sq ft
<br /> PROJECT TYPE: NE.' CC --R.,JCTION 71 ADDITION ✓ "0-NAND IMMPROVMENT ❑ REMODEL
<br /> BUILDING USE: L SFP, ;'s'NHOUSE El DLi i~,DU T. ML"T A`LILY-#OF UNITS: 7 COMMERCIAL
<br /> " k,•, " i , , RI T'IC F: WORK
<br /> CONTRACT PRICE OF V,' - `7)0. !ASSOCIATED BUILDING _ MIT#I f nogItcablei:
<br /> DESCRIBE SCOPE r. .
<br /> Install 20 cal'�C�p, _.__` -.�. �.� w..w .�_
<br /> THIS INSTALL,-ti7 ...: -<' THE FOLLOWING SCOPE: (SELPCT ALL THAT APPLY)
<br /> LINE VOLT AC,i ',:O 7 YES-Select Scone:Li Service El Feeder ❑ Circuits-:., El Complete Re-wire
<br /> LOW VOLTAGE YES #of Devices:
<br /> SELECT SCOPE'RE-,',i - -, -- . -1 intercom L i!r-r '---stet L Audio ❑Secure Access 0 Security System
<br /> " °cc = v r ii..cie electrical wiring rough-in of the system.An additional
<br /> I ' r€: :son and installation approval.
<br /> IS THIS PERMIT -.,_ . .-,-,_ ,.EALT'iH AND; ... -.RE FACILITIES: NO LT YES--See c:elow&Pg.2 I
<br /> By . . r V, 46B-900,selected the specifi is..eon on page 2
<br /> of 1 ' page,, ,. ;.-, meet all of the following sub se... ^s that do not
<br /> See?age 2 req.
<br /> LICENSURE Below&Pg.3 i
<br /> ARE YOU AN Oki— r vaE.w,• _ .: .
<br /> PL.,: .:r Ical work on b:.l.:. ,, or lease
<br /> wit`_- = is box,I am stating that I hav Meted and
<br /> See Page 3 sig. ,..:, - .. .._W . _, ,-:n this licensing/certification . -.ant.
<br /> s.th . . .
<br /> �a._._
<br /> ii
<br /> OWNER NAME: :ommsrcia. :
<br /> OWNER MAILIN( �— i)
<br /> . -. ., STATE\'VA ,G2O i
<br /> OWNER PHONE'
<br /> t
<br /> N
<br /> CONTRACTOR NA3�1 _ �, .
<br /> 0,CONTRACTOR Au:, .,S ,3 Sn.,. »°"`:'s' Ave `�``
<br /> 1 ,
<br /> STATE WA 032
<br /> CONTRACTOR 1- ack@ols01electric.net
<br /> CONTRACTOR L i. --Si7.7;;ElS33PE ..,VERETT EASINESS LIC.#(RE:3UIREO):0iry,02
<br /> 'PRIMARY CONT., ,4....
<br /> CONTACT NAME-
<br /> 'r.,,, ., iii'i >:. ., ,.;.net
<br /> AGREEMENT:t hers " ex..^.. ,this a„p.caT or,,-? - . ,r..,:,, :Tract. All provisions of laws and,„ .:r.governing this
<br /> type of work will be a.. ., .• .thor#y to violate or ca;.cel the r:_: . .i any other state or
<br /> local law regulating a
<br /> •.._. .; arty to perform the work for wn,`cn - an is made and t
<br /> comply with the State.';o:, ..., , ,.,. Ci of Everett 3. Jse Only
<br /> PERMIT#: 1
<br /> E Ob \ �Taras Krysa �i2={ 2)/2 '
<br /> Owner/Authorized A to ,,k itv ,4._ ;slot: (Revised 1�„/201v,� � ,e 1-Application
<br />
|