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IIIIIIINIIIII 10 Is ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERET7 PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-885-1 1 (E) everetteps@everethI I www,evered".gov/permits <br />WA"INGTON !IT <br />I 1 110 11114C 1111111 , I <br />M�TTWII_ Ml M <br />PROJECT A , DDRESS: 2009 Fairfax Ave BUILDING AREA: <br />CTION W] ADDITION TENANT IMPROVMENT REMODEL <br />PROJECT TYPE: EJ NEW CONSTRU LTI-FAMILY - # OF UNITS <br />BUILDING USE: SFR TOWNHOUSE DUPLEX <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />rONTRACT PRICE OF WORK: 0,00 <br />D-ESCRI13E SCOPE OF WORK: <br />Add/Alter 2 circuits for master suite additions. I plug and 1 <br />Lmc, imQTALLATIoN THE HE FOLLOWING SCOPE: <br />_—L'" I r`r_ <br />i.,(i YES - Select <br />VOLTAGEINE WORK?L <br />3,( N 0 Ej YES- # of Devices: C3 Secure Access ❑ Security System <br />LOW VOLTAGE WORK? [] Data 0 Intercom <br />SELECT SCOPE (REQUIRED): rmit onl <br />OThermostat El Audio wiring tough -in of the system. An additional <br />Fire Alarm -Installations under this pey include electrical <br />Permit is required for review of device location and installation approval, <br />...... . . . . . <br />X <br />Fire Alarm Perm -------- <br />ik <br />Other (List All).--------- __ <br />YSee Below & Pg­ - <br />tI <br />177777, RRMN ES R <br />PERSONAL CARE FACILITIES' 00 selected the SPeCfic reason on page 2 <br />ITUTIONAL. HEALTI I AND101 296-46B-0 <br />THIS PERMIT EDUCATION, INST t I have read and understand all of WAC 11 of the following Sbisect ions that do not <br />By checking this box, t am stating that because I meet a <br />of this applicaflion (see next page), AND Plan Review is NOT required wSURE: NO YES -See Below & Pg. 3 <br />require Plan Review, C OR WITHOUT ELECTRICAL LICENSUR : sale, or tease <br />See Page 2 HE CONTRACT cannot perform electrical work on buildings for rent, <br />N_Ep leaseholders I <br />RE YOU AN OWNER PERFORMING WORK AS T owners and I I am stating that have completed and <br />Pursuant to Rr-W 19.28,261, property on, or exemption, By chect(Ing this box tifcation requirement, <br />ical licensing and cerfiflc3ti an exemption from this lic8nsing/C8 !111111111111111111111�-"11.1!!Il—"----,"T"I-I <br />without the Proper eieutt plication to receive <br />IT on page 3 of this aPI <br />,nod the AFFIDAV <br />See page 3 S <br />ALL THAT _APPL <br />ft <br />COMMERCIAL <br />Complete Re -wile <br />Pro.com <br />MAILING <br />C�Ty <br />PHONE' <br />Garner Electric WA LLC <br />kCTOR NAME*. STREET 402 Vail, <br />-HONE, 253-872-6051 <br />GARNEEM64r,D <br />LIC. <br />CONTACT* <br />7 Service [] Feeder D Circuits-* <br />.se�kc���� <br />NAME <br />Ave NW Ste 106 <br />[OTHER (Please SP`acIIfyi - <br />ACT PHONE: 253-278-7064 <br />WA <br />LIC. <br />RM <br />,, 98371 <br />052909 <br />-014TACT NAME* Ire—ONTACT EMAIII peIjis@gvveuSa,c0m diriances govI th6 <br />.......................... I_ of any other 5MI <br />Patrick E�31is I . ............ <br />........... 7,—P—Pl`Z location and know Me same 'a oe violate or cancel the Provisions de and <br />,ty to perform the work for which application 4 Ma <br />I have reed and examined of a permit does not Presorne to give authority to <br />rG_R_EE_M_E-�NT 7rl;b-y �517177 that or not. Theg'sn"n' edbythewrielofthiSprope, <br />type Of work will be completed whether AP-cified herein That I a r. c of Everett <br />y fuction or the pelformance of cOnstruct'on- <br />local law regulating coris Law 16, 27 RCW and 296,200 111 PERMIT #: <br />comply with the Sr4t, Contractors C) <br />E <br />Page 170pk8tt <br />Date <br />(Revised 1/f 1 19) <br />'10w2­nerlAuth.rized Agent gnatute Date <br />