811 SE EVERETT MALL WAY T MOBILE 2022-01-14

re ICI EVERETT WASHINGTON 0 E I-RICAIL, PERMIT AI F"Auk-ATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT" SOTE INFORMATION PROJECT ADDRESS: 1911 SE EVC-ft-T-r MAiL_ WAY src t A IEV RET7 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT rtA REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: COMMERCIAL ELECTRICAL APPLICATION ONFORMATOOM 8, nESCROVI Y IOM OF WORK CONTRACT PRICE OF WORK: $ 500 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: 0-100K V i CI') S1` I/ 1d)MIrVPr76,0 S/6k) & )? (A13/Q, " i- IIAOWL6 "TO &h-IS Ilv6- pavwc. S1610 Cy1t2CU17 ®oN ( 13Y 071-16AS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ZINO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO 71 YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional Fire Alarm Permit is required for review of device location and installation approval. r Other (List All): ) (rN CODE C®MPUANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: '• NO YES See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296466-900, selected the specific reason on page 2 of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: FLINO YES -See Below & Pg. 3 ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that 1 have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT ONFORMATION OWNER NAME: Fnti) (��pQ�l? jy fLt1VNA6GmCA)-r TENANT BUSINESS NAME (If Commercial): p -- P1u,(3A6 OWNER MAILING ADDRESS: STREET 6219 P57."' PI_ !V C CITY ReomaNp STATE ZIP 79,051 OWNER PHONE: 206 9Gi2 -733'- OWNER EMAIL: 1Md.P'_0Per_4'j -- �� ^^`�'� CD A CONTRACTOR NAME: 14,1541-"14 A/ojL-,,1_) (S CONTRACTOR ADDRESS: STREET 2710 IBSrr" 6-r G-r S. CITY LA1<C-V IoO.t) STATE 71P -2t)"V99 CONTRACTOR PHONE: 25z?, 91 1 CONTRACTOR EMAIL: 6� 1-0 _'i c h ' wCS-fr: e0M CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 4t/ 6 / 7 PRIMARY CONTACT: DOWNER LjSCONTRACTOR MOTHER (Please Specify) CONTACT NAME: CONTACT PHONE: .25y9s 7091 gelp,N i3P oSA/AW CONTACT EMAIL: Wi,0Snan he.6,401 / We44. Corot AGREEMENT.• 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances 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 provisions of any other state or local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: io...Xe EU�OJI7� O orize re Date (Revised 1/1112019) Page 1-Application