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1 0 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9MI <br />IM 425-267-NIO i FAX 257-8857 I (El ��t= Ssr�cati ,fly 1 want t, r�l� rl�errn�s <br />~d <br />PROJECT At'?mEw L Z�u1 ASSoGt A) �Lv� S"TK- 1 BLULt3IfoICL AREA: it <br />PROJECT TYPE. CI� coNSTRUCTit t E3ADDITIO TENT I f'RCii 4EN I E DEL <br />BUILDING USE E3 3FR 13TowNH fuse a DtjPL x E3At )u 3 h�ltii.T1-�AA� y w UNITS,� � �l � CIAL <br />RACT PRICE tit" : � � AiORK$ E13vcASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRISE SCOPE OFi1 ORK: � >Q>r A "T �AAJT <br />LIi� E OL' A WORK? t!ti YES - Sit S j Servir ear Ciro It CCsfr slate I wire <br />LOW VOLTAGE WORK? 13No YES- # of t)evices: <br />SELECT SCOPE. (REQUIRED): Meta 13 intercom O Tt rn3ostat 13 Audio E3 Secure Access E3 Security Systarn <br />Fire Alarm - Installations under this permit only include electrical wiring rou -Ire of the system» An additional <br />Fire Alarm i ut is required for review of device location and installation awaval, <br />® ottier (Lw Au): <br />.ANE <br />6, e <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL. HIEAL.TH Abiom CARE FACILITIES. CAFACILITIES: No YES »- See Below S P9. 2 <br />IjBy omeking this box, I a alxdt that I have read and understand all of WAC -�#5 , selected ti* spWiftu reason on 2 <br />of this appllc (see next page'), AND Plan is NOT required becauseI fret all of the following sub sections that do not <br />Sees Pafya 2 rare Plan. <br />YOU AN OAR PERFt7Riil1 NG WOW AS THE CONTRACTOR WITHOUT ELECTRICAL LIC URE. ES -See Maw S Pg. 3 <br />Pursuant to RCW 10.28.261, prop" mars and lessehokl cannot perform electrical er l work on buildter rent, sale„ or lease <br />vWout the prig electrical ti rising and certif , or a r4 tan. By r iteJft this box, I m stating that I have completed and <br />See p 3 signed the AFFIDAVIT ter } 3 of this application to receive an exec ption from this li its cartlficat' requtrwnent, <br />ER iSdAitE. N Ysww �t'� Ti NANT BUSINESSNAMEIf Gcunsrseresat , �pAS7 t_ <br />OWNER MAILS ADDRESS �r r r'v J-AAA 3 S 73 <br />c CLL�vul_ STATE <br />OWNER PHONE: ]OWNER s EMAIL <br />CONTRACTOR N"E; <br />CONTRACTORAt DRESS,, arrrs�= 90 gJx 1 *71 ) <br />CITY f-IN& �UN� &xA LJ zlv ��f2� <br />CONTRACTOR PHONE: Z-',' 240 t �l <br />CONTRACTOR' EMAIL: -s't F� � $/J H S )Rtr. evY-- <br />FQL4PW s a 4ZY—ti7 CITY OF EVERETT BUSINESS L-IC= REOUIREi? : oS Gg ri <br />CONTRACTOR LICRIM <br />11. <br />PRIMARY CONTACT, 13 t�WNER� CONTRACTOR 0 OTHER (Please Specify) <br />CONTACT NAME <br />CONTACT PHONE: Lj2 r ZN yt % �1 <br />CONTACT FII�.; <br />��Ff ��S�rto <br />_ hang d filii@ s �t&u, Md kAM the ssrr+d s, and off thR <br />type t �vvr t be, 3rsr , u r rho Wad *to s r pos" la give aatfhcxO to data ruF� t7 oWsk;ns of ark oftrstafe or <br />Wei kw r € ttr� tkrn on iet� cs of car nidkA That f ant Mh**0 by ft ox r of tiers pmpwtyto p�rrr the m*Wwfth av r,t a to mods and I <br />crnpty : the stateCoohectrxs Low 7827 t �` and 2 ,2t7 VfAC C of E Official V" <br />;t� 1) 2a 2c72 y <br />kuftworlmd Agent 8ignatum mate isad flffix1'9) Pane I-Appkcation <br />