Laserfiche WebLink
• S <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> . . ., 3200 CEDAR STREET,EVERETT.WA 98201 <br /> (P)425-257-881O I FAX 425.257-8857 I(E)everettesps•t averettwa.gov I waw.evereitwe.eminerrrpis <br /> PROJECT ADDRESS: 132.S 5E tv OM'r WALL ta3Ay BUILDING AREA: <br /> PROJECT TYPE: 0 NEW CONSTRUCTION D ADDITION TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: ©SFR II TOWNHOUSE 0 DUPLEX C]ADU Cl MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ 19,9-p �^ ASSOCIATED BUILDING PERMIT*(if applicable"(): <br /> DESCRIBE SCOPE OF WORK: 0vs7a11. , hike- 4 t,AQ a i <br /> { <br /> hTHIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> UNE VOLTAGE WORK? NO 0 YES-Select Scope: Service CI Feeder 0 Circuits.-It, D Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO YES-#of Devices; L3 <br /> SELECT SCOPE(REQUIRED): D Data 0 intercom 0 Thermostat CI Audio CI Secure Access CI 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): _ _...._.__.._._....�. <br /> _ KtAte•Iq iPiw' r r l w°u,;, .r 0 N'yV e <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:1E NO El YES--See Below&Pg.2 <br /> By checking this box,I am slating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 <br /> �...J 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 Pare 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LiCENSURE: 3NO DYES-See Below&Pg.3 <br /> D Pursuant to RCW 10.28.261,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 en exemption from this llcenslrigicertification requirement, <br /> OWNER NAME: FLY rid 4-, SRvft t4 Shtfilei TENANT BUSINESS NAMEUtf cornmercialli <br /> 5OWNER.MAILING ADDRESS: MEET 13 zc 3t E.vtt 1T h'1A1-1. WA <br /> CITY ii.V.Eit n STATE WA zer rg <br /> OWNER PHONE: OWNER EMAIL <br /> CONTRACTOR NAME: f3 4 N F <br /> CONTRACTOR ADDRESS: stare QC2 �x 7 I I <br /> clrr AR-L.!kJ(,�1 STATE an -1 v 22 3.... <br /> CONTRACTOR PHONE: y?S 244 I tic CONTRACTOR EMAIL:-SLFF C BIN)H FlRi. Car. <br /> CONTRACTOR LIC. 1-16 1 F`b�2K� (CITY OF EVERETT BUSvs ISS LIC #{REOUIRED S�V (/�i7 <br /> �s.H ? NE aM1 <br /> PRIMARY CONTACT: D OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 11215 244 1445- <br /> �CFY L�RuSSAf2 ) CONTACT EMAIL: �GTF Q 13o014 nt:l=.,�d'!'� <br /> AGt hlt:1 hereby candy that Aavaa read and Mumbled anoticaden anti snow the same to be true and correct. Art provfe ns of revs and ordinances governing Miss <br /> type of work wade LOmpleted whether wed( tin or not. The granting of a permit does hot presume to give authority to vivlere or cancel the provisions of any other state or <br /> focal law regulating constrrrctkx,or the performances of Olandruenan, That t am authorized by the owner of this properly to peddm the work for w*kth*grander;is made and I <br /> comply with the State Contractors Law 18.27 RCW end 200 200 WAC City of Everett Official Use Only <br /> PERMIT#: <br /> e‘ 7) E2_1 © 6 - 11 <br /> Owner/ rio zed Agent Signetote Date .(tevi d 1/11/2010) Page I-Application <br />