902 N BROADWAY BROADWAY DELI MART 2022-04-04

E •LECTRICAL PERMIT APPCATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINOTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: (1C11 �I ai,ei LiiF;; r4iP BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE El DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ gen ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: -f-C,,I I 4.1614vei i�5 en II THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO El YES-Select Scope: ❑ Service ❑ Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio El Secure Access ❑ Security System El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑ Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El/NoCIYES—See Below&Pg.2 flI By checking this box, I am stating that I have read and understand ail 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 followi g sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO EYES-See Below&Pg. 3 I I 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: J7 €?t 1yfA4A C.jn 6 TENANT BUSINESS NAME(If Commercial): RyP:,,,PLL,j t)- ` 1,i4 y OWNER MAILING ADDRESS: STREET 96.2 jf gwejt.Y%y - ir A CITY f Vevei - STATE i„.„A ZIP 9[,�0) OWNER PHONE: 4 —773 -,— S/ C !� OWNER EMAIL: ( 0Stic n;c?, 1 neitt-,�„_ y�,, O CONTRACTOR NAME: 5'7j p j S- •S CONTRACTOR ADDRESS: STREET i `/ ©% f�� •� �'/f •A �] / CITY tom/►, n f.J a. 14 / _1 STATE t,✓A ZIP 9,g6 s?`L CONTRACTOR PHONE: 4 a ..�,Grt /'CONTRACTOR EMAIL: E'(�1 S- x,,i,6d . $,i11 CONTRACTOR LIC.#(REQUIRED): 5 P am' :,Gi i CITY OF E�VERL=TT B INESS LIC.#(REQUIRED): S3 9 PRIMARY CONTACT: DOWNER CONTRAC/TOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ` 2?-3 ---,7-7i-66%� CONTACT EMAIL: AGREEMENT:I hereby certify that I h ve read and examined this application and know the same to be tPute and rrect. A l provision6 of laws and ordinances 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 provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: s ;di- E 2ôS - 09S uth- ent Signature Date (Revised 1/11/2019) Page 1-Application