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ELECTRICAL IIIIPRMIT & FIRE ALARM PRMIT APPLICATION CITY OF EVERETT PERMIT SERVICES OLT 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PRO f CT ITE INFMATION PROJECT ADDRESS: 1 `fil \\ ,:. c f * PROJECT TYPE: ❑ NE STRUCTION ADDITION M ENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION .> CONTRACT PRICE OF WORK:$ if ASSOCIATED BUILDING PERMIT#(if applicable): - IS THIS LOW VOLTAGE WORK? E N YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & COD COMPLIANCE 1 DESCRIPTION OF WORK: 1-��\k� - {-t, 'c tj,E.,�i r4' 1 1 4- 01114 IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: O ❑YES--See Below&Pg.2 ❑ 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 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: 0 DYES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for 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: 1C3E \ \id1 f TE ANT BUSINESS NAM If Commercial): OWNER MAILING ADDRESS: STREET -7 i 0 M .. CITY -S4 STATE �, � ZIP ti gOVZ OWNER PHONE: 'OWNER EMAIL: CONTRACTOR NAME: / \`'jt— iC � h 4 CONTRACTOR ADDRESS: STREET a, ^ ` CITY kL- STATE ZIP C(q 1 CONTRACTOR PHONE:(Z24^4/OS:4416"ic CONTRACTOR EMAIL: 11>1.—(j— /-eL—kii‘k'(,_ E L�,�I. WA.. )-�.�� CONTRACTOR LIC.#(REQUIR : �l4�+ _, 1-1 C) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �) 1 1� 111 PRIMARY CONTACT: OW R ❑ CONTRACTOR ❑OTHER(Please Specify) T T NAME: 2 CONTACT PHONE: I9 `(, l'— Z Vc1 L Ql CONTACT EMAIL: ZAK y `: to v\c . h AGREEMENT I hereby cc Ty t at I 179.Ve rea.and examined this application and know the same tb be true and correct. All provisions of laws and ordinances governing this type of work will.e c.'plete. whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any othe state o al law r:.ulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is ade and I omply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# -E\ ea 2__ oca 2_ e t )f) I 'I) 0 er/; thorized A. nt :"gnature de (Revised 11/5/2018) Page 1-Application