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min <br /> EllICTRICAL PERMIT APPLI T$O <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERE I t,WA 98201 <br /> WAS ;vc TON (P)425-257-8810 I FAX 425-257-8857 I(F)everefteprogeverel vevey .everettwe.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: (p 20 S . Evefei+ )Y)ri 1, ti ' e ZCc.) BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION glIKTENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: Li SFR ❑TOWNHOUSE ❑ DUPLEX TI ADU ❑ MULTI-FAMILY-#OF UNITS: An COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ B5 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: in (i) LE A) stir a 13p kaLi <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ( NO El YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: C Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ,YES-#of Devices: I <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System <br /> ❑ 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(List All): Si4C) <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: "RNO ❑YES—See Below&Pg. 2 <br /> riBy checking this box, I am stating 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 all 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 LICENSURE: 1O EYES-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 /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): jre t.Nmex <br /> OWNER MAILING ADDRESS: STREET (,ZED t5E v Mc(i k (A300-1 /�' zooc� �a �J <br /> aTv E\I�r��l STATE w A zIP 9 (1 .0 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ba-)r. t k. 1') <br /> CONTRACTOR ADDRESS: STREET I�n/ )7 1 &\- e <br /> 1Q) - E ✓eil- F2. 5 <br /> CITY 1 I I ("fee \ STATE \Al A ZIP 9 620 12_ <br /> T <br /> CONTRACTOR PHONE: 11i�2•3.3 3 ) r'b011 )j CONTRACTOR EMAIL: b+( r),5Q,„An 5 f ( 0111 <br /> CONTRACTOR LIC.#(REQUIRED): ?P- T `,�i S 9 90,PcJCITY OF EVERETT BUSINESS UC.#(REQUIRED): cy95 (`J <br /> PRIMARY CONTACT: ❑OWNER XONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: F'Unv, / z.\ J CONTACT PHONE: �� 3 Q,�'j i (0 <br /> 1, CONTACT EMAIL: bh s tcj r s( �S h- Co <br /> AGREEMENT:i hereby certify that l have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this <br /> type of work widf 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 co..Sttwtim or the performanceof=stnictim That lam author ze by the owner of this property to pa„rm the wal,cr.whicM application is r'iade and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 0/ 2-1/26Lo E Z�\ - drA d <br /> Own:-IA o -ntSignature /Date (Revised 1/11/2019) Page 1-Application <br />