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ELECTRICAL P*ZMIT & FIRE ALARM PMIT APPLICATION 44 �w CITY OF EVERETT PERMIT SERV ES 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 SITE INFORMATION PROJECT ADDRESS: 113''1 hlt h 0/P, d dr 151c d- IV %6;4_3 PROJECT TYPE: ❑ NEW CONSTRUCTION ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: 11,SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - #OF UNITS: ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION Ii CONTRACT PRICE OF WORK: $ boo 1ASSOCIATED BUILDING PERMIT # (if applicable): IS THIS LOW VOLTAGE WORK? ❑ NO YES - # OF DEVICES: 2 IS THIS A FIRE ALARM PERMIT? NO ❑ YES - Plans required for review (Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK A CODE COMPLIANCE DESCRIPTION OF WORK: of arew e k r Alt ceI4 6-i r- .6pe" IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: RNO ❑ YES -- See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-4613-900, 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: O OYES -See Below & Pg. 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildingfor rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: (� 1 �fU� TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 7 o *ktid 0 Cy CITY L t t STATE ZIP OWNER PHONE: Gu C( 4/ OWNER EMAIL: ��% /�9W e/�'C' vC" IOf CONTRACTOR NAME: U QM10 E 6/G LL CONTRACTOR ADDRESS: STREET 79 G., n r Ol' l., i'/(�(�C STATE ZIP / O /CITY CONTRACTOR PHONE: L�7ip �I7 6 `�!� _ / L' Y/�_ �_I CONTRACTOR EMAIL: LL gGr� /Jr eleclnc ` Gl��c� O v CONTRACTOR LIC. #(REQUIRED): (%[ J�3 r% d 2 ICITY OF EVERETT BU INESS LIC. #(R QUIRED): PRIMARY CONTACT: _ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: 1� 1E -i CONTACT PHONE: CONTACT EMAIL: ccr' AGREEMENT: I hereby certify that I have read and examined this application and know the sam4 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/ am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. (4/1�1 r n%/// Zti 0 Own, r nt Signature Date City of Everett Official Use Only PERMIT # (Revised 111512018) Page t-Application } t