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0 0 <br />Tiqrdu_���O kill <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8�] (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SIT NOR .. ATION <br />PROJECT ADDRESS: 3/S - CAS//V Q "J90FRA <br />EA: � } sq ft <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION TENA T,IMPROVMENT FKREMODEL <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX 0 A�U ❑ MULTI -FAMILY - # OF UNITS: R� C:OMMERCIAL <br />ELECTRICAL APPLICATION INF . MATION A DESCRIPTION"OF WORK <br />CONTRACT PRICE OF WORK: $ by <br />ASSOCIATED BUILDING PERMIT # (if applicable): -- <br />DESCRIBE SCOPE WORK: IW469— e-E - CbtYN�� �W � A-� j�4/If� <br />�apt`�,�OFF <br />�/ -F-r— ArJ <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT P Y) <br />LINE VOLTAGE WORK? ❑ NO !31 YES - Select Scope: ❑ Service ❑ Feeder X�Circuits-#: ;1�❑ Cg4nplete Re -wire <br />LOW VOLTAGE WORK? NO ❑ YES- # of Devices: <br />SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ A dio ❑ Secure Access ❑ Security System <br />❑ Fire Alarm - Installations under this permit only inclu6 electrical wiring !r9-pgfiLin of the system. An additional <br />Fire Alarm Permit is required for review of device locatio nd installatiort°pproval. <br />❑ Other (List All): <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: O El YES -- See Below & Pg. 2 <br />❑ By 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: NO DYES -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 />y 5� <br />OWNER NAME: y6 �// — naV TENANT B�U„SI'NESS NAME (If Commercial): L�MIL-U G �f Arei-64 <br />OWNER MAILING ADDRESS: STREET 700 �IIrE_ —CJV,— Sl1 o-F— <br />ys/� <br />CITY Y____V 'rt_ STATE ZIP <br />OWNER PHONE:' ���� '-/jo <br />OWNER EMAIL: N <br />CONTRACTOR NAME: 6AE57— C+ J - 6' ^ 'hS1 C- <br />CONTRACTOR ADDRESS: STREET <br />ZIP <br />CITY STATE A <br />CONTRACTOR PHONE: LSJZbS-Tbd� CONTRACTOR EMAIL: (ptg�NurS6 (DAeaM�6�-C-00 <br />CONTRACTOR LIC. #(REQUIRED): �� q%rn� CITY OF EVERETT BUSINESS LIC #(REQUIRED) y Otn 0.3 <br />PRIMARY CONTACT:._... ❑OW,.,_ <br />NER FVCONTRACTOR ❑OTHER (Please Specify) <br />CONTACT NAME: , <br />l IN7 <br />CONTACT PHONE: G'J `2_6 <br />CONTACT EMAIL: ttf/ -rillP t? /-40+01-fI-Ee 007 <br />Au ., of tau -a nr(linanroc nnVAminfl thin <br />AGKLLMLN1: 1 nereoy Cerny mar i nave read anu exammeu uus ayNnual—, anu �..�.. �� ••� w •� �. _.._._.._ _.._-- _ __ - - _ <br />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 <br />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/ <br />comply with t ate Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br />r PERMIT #: <br />hill E <br />Owner uthorized A on t ignature D e (Revised 1/11/2019) Page 1-Application <br />