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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVeRi TT KRMIT 6EHVICES <br />3200 CEDAR S1`RCET, E RETT, WA 08201 <br />(P) 425-287-8810 I FAX 426-257-MY I (E) I wAw,tmirettwa.SlovlperMAs <br />G <br />i�"x�.„/„ - •`t.�•S4 _ . T :`s;; ..�`fiS ,. �y i... •a ;' w i, R. �� a3+ z� `'�i$ � �",aar <br />PROJECT ADDRESS: 7_ 7 07 Got.133y Av6 O CcD ( BUILDINCd AREAL ft <br />PROJECT TYPE': D NEW CONSIRUCTI[ON 0 ADDITION-'ADDITION-'S TENANT imPRoymENT DREMODEL <br />BUILDING USE- (I 5FR 13TOWNHOU$E O DUPLEX 13ADU 0 MULTI<FAMIi Y r # OF UNITS. � COMMERCIAL <br />CONTRACT PRICE OF WORK. 4 `ttw -t= JASSOCIATED BUILDING PERMIT # (if appficabla)' <br />DESCRIBE SCOPE Of WORK U1-0CAA_TfL .SPEAr.EM <br />6 e e.Av_,e R. .S'f fi.c) r3E> _ -To a,,t T ,} Ave a� f3LG v I suR C c v E RA <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY <br />LINE VOLTAGE WORK? _'_Q NO 1 YES . Soled a Service O F adar Glrcuiia ?); Carrri�tt3t� din wtr� <br />LOW VOLTAGE WORK? 13 Nth M YES- t0of t"sr3v o,,� % _ YwE3'Audis <br />SELECT SCOPE (REOUIREO):: 13 testa 0 intercom OThermostat 13 Secure Ac s 13 secur#ty System <br />Ctd Fite Alarm . Inatallatinns under this permit only include electr(r:al wiring rough -in of the syttern. An additlono3 <br />Fire Alarm Permit is required for revt rr of device location and Installation approval, <br />❑ othor <br />I3 THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARTE FACILITIES; No YEB ,_ S Bslow & Pp: 2 <br />By dveking this box, I am stating That I have read arul understand all of WAG 2964E 0, salocted tho sper.1fic reason on page 2 <br />of this Application (seer next page), AND Man Review i4 NOT requiroo because I fa"t ail of ow followir g sub sections that do not <br />s Pao 2 L"Wro Plan RwWft. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE. MNO MES -See Nitro & Pg, 3 <br />Pursuant to RCW 19,28.261, property owners and leaseholders cannot perform electrical Work our buildings for refit, sale, or Tease <br />Wftout the proper oledrititt licensing d w6fitwtfon, or exarnpition, By dwAhg this box I am stating that I have completed and <br />seta pap 3 signed this AFFIDAVIT on p 3 of this application to receive an exemptim front this Itcarrakwoertification requirement <br />WN NAME. 5?*X'5-7 Ar`t9rL.1C.AP j -rITLtk TENANT BUSINESS NAME if Commercial <br />OWNER MAILING ADDRFSSs wntest Z-70-7 t.:ot. A.'V � <br />Q <br />My L,`, t, eru _. 1 STATE <br />OWN PHOW: OWNER EMAIL: <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: rsTPURr <br />Grry AOLLIX)t jtxJ rarner W/1 NZ - <br />CONTRACTOR PHONE, '/25. 22,0'q lgft,S" <br />CONTRACTOR' ENIAIL: -_54' Jf2Cr..CA)V". <br />CONTRACTOR LIC. #Fit tdUIRE $� ;Y1 R Qy �� 4�7 CITY OF EVEIiET t BUSINESS LTC, # rtrOUIRCD : c� a'S <br />PRIMARY CONTACT. OWNER CONTRACTOR. .C3 OTHER (Ptetrse Specify) <br />CONTACT NAME, <br />CONTACT P E: <br />CONTACT EMAIL: :r 6 f i Q!, 8&) H f jp e _ C v,✓►�, <br />rs . +' ..e.u. ,rrew + anre taav sane pxaarariars arras vowAimm aw rtn(Av [no Wne to aft Trig arm #<C?rMa. ASS prr vrarorrs tti r#Ws arrcr C7JRt.!l�rirr3Rfi g rr tA18 <br />$} hi u c vita dt6�t'#Hr w' rral; fire {ymwktv ntA rkW Pt0W V 10 br 001" ttt W.W40 Car CW9e1 tffi PMVt Ufl4 29arty ()f11V"*W0 Or <br />i %1vYf jtr%7tbt9 t 8trrlCt Ni LY tlrtt pttr&urrrgrtG �t $Ur7�ri ioA 7haal t AM Hlr?iKSt'ized b dw o of this propel y to paf&m 00 wotk rctr whk-h Apokawlf to msda and 1 <br />uorrrply nt�CfP itta ; I ractcva t. 7&,�It� �C�V anti 2aB.a0r3 4VAC;. CIt h�.eiftcl� �nl <br />P MITI' <br />I' t la �'Z I V <br />trtheri Agent 6lnettrrs , f/f i) a pttartlrttl <br />