|
. • •
<br /> - 01°111P
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF evERerr PERmiT SERVICES
<br /> ,
<br /> '41:1411W"" r 3200 CEDAR STREET,EVERET T.WA 9-82e1
<br /> (P)42,5 257 rt5ii.) l TAX 42257-8657 I n evevotleasetwerativra nay I w000reveraitara.euvipernds
<br /> ,. ' — , :i, f i.ge,„,..;',4,4,401.is.... ...V.A.;• ,..t-,-4,-''' 4.1.2,4„„;:i1-17:--,. .'',744,41/4 /:•`-7.;:,-;;:i.43,71.7-1-T.:;.,',4 , ''
<br /> PROJECT ADDRESS: 'Leto;. r---, ia.y 1=11'tr SUILDBIG ARFA:_
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION—El TENANT IMPROVMENT Cl REMODEL
<br /> _
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX El ADU 13 MULTI-FAMILY-*OF UNITS: -43 COMMERCIAL
<br /> ;,74:er'71 .-vvoitit :,,z,,,;:--,-z..--: -' -,--..
<br /> CONTRACT PRICE OF WORK:$ Li coo -44-= ASSOCIATED BUILDING PERMIT Al(V applicable): C)-- * 111
<br /> DESCRIBE SCOpE OF WORK: in_FrAu- Dr:Nc,A-TE,p Fl_i_ Toot.) pANse.L. -... b,
<br /> —
<br /> _ 1 ,
<br /> IS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY
<br /> LINE VOLTAGE WORK? -El Nii r sz- - e, co. i.: * Se - ..,.. C]Feeder C]Circuits : 0 Complete Remrire
<br /> ..,„
<br /> 151
<br /> LOW VOLTAGE WORK?(,----INO YES-*of Devices: 4 ,
<br /> SELECT SCOPE(REGLalitsta 13 i n terc lIrn CI 1:t-=..-= CI Aud 1 o Cl Secure Aatess 0 Security System
<br /> -13 Fire Alarm-Installetinne 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 instal/aeon approval
<br /> 13 Other(List Ati):
<br /> -
<br /> C* *. ",' ,0-ri7;VTT"i'T-'Tg-:lr.i4f*iTtY::,'4:iI:T:i'-•.„..-'1,.., ,:>","\-71:f,-..,,zP,'?-f,-,,- ..:.--,-,4., .,..,,,,, .‘
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDfOR PERSONAL CARE FACILITIES: -3 NO • YES--See Below&Pg 2
<br /> 0 By checaing this box,I arn stating that I have read and understand all of WAC 296-46B-S00,selected the specific mason on page 2
<br /> of this application(see next page),AND Plan Review is NOT requited because I meet ell of the following sub sections that do not
<br /> sea Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO trYES-See Below&Pg.3
<br /> D
<br /> Pursuant to ROW 1g,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 Disc I am stating that I have completed and
<br /> • gee page 3 signed the AFFIDAVIT an page 3 of this application to receive an exemption from ibis Neenitingicertiticetion requirement.
<br /> : 'ii''''':?'57-S '..;i1.,-,,t,,t-,°, , --,:,.;iv' „, ;,..;:- •,. ' ,,IN _ . ., ; ,e
<br /> OWNER NAME: SX-CrICAN(-- TENANT BUSINESS NAME If etitttrattitlal
<br /> eWNER MAILING ADDRESS: wear/ Z-707 Cot.84-) AvE: * _
<br /> ary EvEA.b—rr STA/r 1frJA Ze 9 cif ZAD) 1
<br /> *WNER PHONE: H zSZ 6-3'o ) OWNER EMAIL:
<br /> CONTRACTOR NAME: 134 II f Ai
<br /> .., ,
<br /> CONTRACTOR ADDRESS: smut PO aOtk 3,i j
<br /> care A iv-wczrot...) awn 1.4 A ZIP 92)Z.Z.3
<br /> CONTRACTOR PHONE: It2- atm 1 CONTRACTOR EMAIL: .n-s..5-f-a2 StQHFIXE•C-Orvl
<br /> CONTRACTOR LIM REQUIRED?: EIHfie.3-1F134 zs.A,..1 CITY OF EVERETT BUSINESS UC,tkREDUIRED: 5 64)
<br /> PRIMARY CONTACT: DOWNER --fil CONTRACTOR 13 OTHER(Please Specify)
<br /> rlONTACT NAME: 117.0NTACT PHONE: I/Li; z.st y ILiti S''''
<br /> 1 J-J.-fiSSAinfi CONTACT EMAIL: 3-EFF a. Is,,,,)4,1)RE•conn
<br /> AGRO:ElliNT:I AirOln.6'erldl'that 1 hew reed and VratinMil-AS sap/we/kw/end know the same to he ors and wheel A i peewees,*n f taws end ettknaneesprensteleti this
<br /> type a WOrk WS be ccomhated whether epoch's,hewn or ste the greeting of a perm"does sot meals°to gee asitarityle vibrate or canoe/Me°toothless of say et her Meta o
<br /> groat low regutaling ConStmchoo re the porterneme cloaeskudion That Ian authorized by the ow e e rot titts property(e perform the work toward/appirearion is mad*and I
<br /> eraripm with the Stele Contractors Law la 27 ROW on°296 200 WAC City al Everett Official ties Only
<br /> IDEFilliT t
<br /> )I- )3_,9
<br /> Owner/ limited Agen Marshes Data i.reiiitaeri firrhiffai Page lApplication
<br />
|