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ams • •
<br /> in ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETr PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@evereltwa.gOv I www.everettwa.govipennits
<br /> PROJECT SITE INFORilMilrti.
<br /> PROJECT ADDRESS: :0,-:"!::: ,„p,,,,,,..:,%17,.,,,,,4-4 151/ :k.k,51j134-"t i,,„tof !BUILDING AREA: _ &xi sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 11 ADDITION Irig TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: CI SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0:4 COMMERCIAL
<br /> ELECTRICAL.APPLICATION.ISIIPORMATION & DESCRIPTION Of WORK
<br /> CONTRACT PRICE OF WORK:* DO ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> 1
<br /> DESCRIBE SCOPE OF WORK: /Igor\ oat. From sec_orNy qdre)t, ) Aki,) rhrier- 14 1014..101.
<br /> i'lvvt... otern
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? Ill NO 0 YES-Select Scope:0 Service 0 Feeder 0 Circults-#: 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? 0 NO g YES-#of Devices: .1
<br /> SELECT SCOPE(REQUIRED): 0 Data 0 intercom 0 Thermostat 0 Audio 0 Secure Access QrSecurity System
<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 /> 0 Other(List All):
<br /> ...
<br /> 400f COWPIA
<br /> julkei
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: r NO 0 YES--See Below&Pg.2
<br /> By checking this box,I am stating that I have read and understand all of WAC 296416B-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 LICENSURE: NO OYES-See Below&Pg.3
<br /> — Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<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 receive an exemption from this licensing/certification requirement.
<br /> CONTACT INFOW4TiOti '
<br /> OWNER NAME: ..4 ,AC ,Crei TENANT BUSINESS NAME(if Commercial): 1,0erlA y,1
<br /> OWNER MAILING ADDRESS: STREET
<br /> WY 1 (=AO STATE k.:;'71 ZIP /4/245
<br /> OWNER PHONE: .6.55 227- 6$zz OWNER EMAIL:
<br /> CONTRACTOR NAME: ( h jt tCA, 1,n i...,t,i Sy(16.4.1„
<br /> CONTRACTOR ADDRESS: STREET t2101 7 I 0i3 4h 1A,,e, Ai i
<br /> .ry mri, or) s'r 1,,,..>,;3 zip 9R.22,3
<br /> CONTRACTOR PHONE: 4)25' 102'9S(Dis CONTRACTOR EMAIL: 4.06sLe tAhdtemconir,/ ,Om,
<br /> CONTRACTOR Lie,fitEDUIRED): trty)\k ' " PrALI n SITY OF EVERETT BUSINESS LIC.#(REQUIRED): S t1244, ,
<br /> PRIMARY CONTACT: OOWNER grONTRACTOR DOTHER(Please specify)
<br /> CONTACT NAME: CONTACT PHONE: 112 S-44.3 2 -036$10
<br /> -6,k)h Aer „Sttc9r)iy. CONTACT EMAIL: 10, e tok.„4,t....,sciunyi Ct,
<br /> AtIREEMENT:I hereby certify that I hove reed and examined t a application and know the sotto to be true and comet All pmvisions chews and ordinances governing this N type of work Wgi 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
<br /> local taw regulating construction or the performance of construction That i am authorized by the owner of the property to perform the work for which application is made and I
<br /> comply with the State Contractors Law la 27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
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<br /> t:"3---- *1- 8-iq EP 01 O`d
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<br /> Caidmr0:itt tcrrized Algen mere Date (Revised 1/11/2019) Page 1.Applicatiori
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