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4 <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> f 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I-(E)everetteps@everettvie.gov I w w.everettwa.govlpermits <br /> PROJECT,RITE INFORMATION N <br /> PROJECT ADDRESS % - 0 ST S <br /> PROJECT TYPE: 0/NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT REMODEL. <br /> BUILDING USE: i .SFR 0 TOWNHOUSE 0 DUPLEX 0 ADO 0 MULTI-FAMILY-#OF UNITS: Q COMMERCIAL. <br /> BUILDING AREA: so ft • 1 <br /> ELECTRICAL APPLILCATIION INFORMATION <br /> CONTRACT PRICE OF WORK:$ Li <br /> Cj '"` ASSOCIATED BUILDING PERMIT#(if applicable): <br /> j.IS THIS LOW VOLTAGE WORK? f NO ❑YES-#OF DEVICES. <br /> IS THIS A FIRE ALARM PERMIT? �O 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK&CODS COMPLIANCE <br /> i <br /> DESCRIPTION OF WORK: e,0 6r-E' 5 t x: A '3 'C <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: [ NO 0 YES—See Below&Pg.2 <br /> 1"] By checking this box,I am stating that I have read and understand all of WAC 2964613 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 LICENI SURE:�NO OYES-See Below&Pg.3 <br /> j -'l Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale.or without <br /> f ( the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the <br /> see Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this Icensingtcert'ifcationrequirement. <br /> CONTACT INFORMATION,. <br /> 1NNERNAME: Te4.4 <br /> L4AitU`rP Liz, TENANT BUSINESS NAME(If Commercial): <br /> lo <br /> OWNER MAILING ADDRESS: satr <br /> cIYY STALE ZIP <br /> OWNER PHONE: L -4(43--(-)`'I D- owNER EMAIL: <br /> CONTRACTOR NAmeLIGHTSMITH ELECTRIC LLC <br /> CONTRACTOR ADDRESS: srmccr <br /> crerKIRKLAN© sum WA z 41%034 <br /> ' <br /> CONTRACTOR PHONE:425-825-5552 CONTRACTOR EMAIL:OFFICELIGHTSMITH@GMAtL.COM <br /> CONTRACTOR:LIC.#(REOUIREp);UGHTEL825RF ICTTY OF EVERETI'BUSINESS LIC.#(REQUIRED): 58579 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR Cl OTHER(Please Specify). <br /> CONTACT NAME: CONTACT PHONE:425-825-5552 <br /> E NI E <br /> CONTACT Ehum:JE NIFER.LIGHTSMITH@GMAIL CONI <br /> A,GREEMENT:I hereby certify that l have reed and examined this appfication and know the same to be true and correct. Al!provisions of laws end ordinances <br /> 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 <br /> provisions of any other state or local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the <br /> work for which appkation:is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAG. <br /> city of Everett Official Use Only <br /> PERMIT# <br /> i i i <br /> , 5-titittititc__ to it, <br /> lA Agent Signature Date (Revised 1 if 2018) Page 1•ApplIcetion <br />