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• • <br /> ELECTRIC `L PERMIT PPL1 AT ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> '0—;;41 <br /> "} 3200 CEDAR STREET,EVERETT,WA 98201 <br /> -4440 <br /> E everette everettwa. ovwvrtiv everettwa gov/permits <br /> {P}�a>s 2�7 llet� I FAX 425-257-8857 {f ) �C� � I 11, <br /> PROJECT ADDRESS: <br /> e r '.. BUILDING AREA: <br /> � 1� <br /> ,PROJECT D NEW CONSTRUCTION D ADDITION CI TENANT IMPROVMENT EMODEL <br /> q <br /> BUILDING USE: [3 5FR [3 TOWNHOUSE El DUI LEX C3 ADU 6�MULTI-FAMILY-#OF UNITS C?MivtERC€ALa i <br /> ...,:,:.,..,.::- <br /> CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable) <br /> DESCRIBE SCOPE OF WORK: %A i A-.' IC <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) - <br /> LINE VOLTAGE WORK? ®NO YES-Select Scope:[3 service Feeder [3 Circuits-#: l tl Complete Re-wire <br /> LOW VOLTAGE WORK? O Y S-#of Devices: <br /> CI Thermostat Audio IA Secure Access C]Security System <br /> SELECT SCOPE(REQUIRED); Data Intercom <br /> 0 Fire Alarm-Installations under this permit only Include electrical wiring rough-In of the system,An additional <br /> Fire Alarm Permit is required for review of device location and installation approval <br /> CI Other(List All) T <br /> <.__ ,. ;M` 0 II YES--See Below&Pg.2 <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: <br /> By checking this box,I am stating that I have read and understand all of WAC 298-462-900 selected the specific reason on page 2 <br /> of this application(see newt page),AND Plan Review is NOT required because I meet ail of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE <br /> CONTRACTOR <br /> O NTRA TOR WITHOUTs ELECTRICAL <br /> electrical LNSUwork E:n ail O DYES <br /> -Se,Below&Pg 3 <br /> rn e <br /> Pursuant to RCW 19.28.281,property perform <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 receivean exemption from this licensingicertification requirement. <br /> L. ,`�,�e .A INFOR AI N �. �� I go g'{�y,Ix <br /> y '4 t ca.. a r "� .�xx��� � - :w..�' W .__ y g o : a M?. <br /> DI ,,E N M , �; TENANT BUSINESS NAME If Commercial: .. ''� °(`.L4,,�, .. <br /> t3Wiri)✓Rt1AME: i . +Na <br /> OWNER MAILING ADDRESS: srrteE7� ar s I. """ <br /> OWNER HONE <br /> OWNER EMAIL: ��.,,..,d. . ..: ....... <br /> CONTRACTOR NAiUI)r`. ��// <br /> t �•�^S/ ,X lv <br /> CONTRACTOR ADDRESS: sr MET I STATE ``r ztP <br /> CITY :w <br /> CONTRACTOR PHONE: - ,CONTRACTOR EMAIL, , i , <br /> ' "CITY OF EVERETT BUSINESS LIC.#REQUIRED): <br /> CONTRACTOR LIG �REQUIRED): ,�� _,� . _ <br /> ,PRIMARY CONTACT:m..Ci OWNER »- ONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME: M <br /> CONTACT PHONE: J 7 3 cef Le, <br /> CONTACT EMAIL: ° '— " " <br /> ACRE#VENT,•!hereby certify t s t have read and examined this application and talon the same o be rue and coarse A f provisions v laws and ordinances g any overning this <br /> type of work wilt be comp/Ied°Tv -(spoc�ed herein or not. The granting of a permit does not presume to give authority to violate <br /> te or e work el the <br /> pmvisl0n application is other <br /> e slate <br /> or <br /> host tofu regulating con ruction or the rfonnanca ofconstruction, That t am nutirodsed by the awierof this property P City of Everett ppllccali flea Only <br /> comply With ma State ontreclum LOW 8..27 ROW end pes.200 WAO PERMIT f?: tt <br /> / <br /> -.._ d (Revised 1,191f'2J Page"I-Apphc&Ilion <br /> Owner/Authorize, A nESignatur ate <br />