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ill 111/ am LIII ELECTRICAL PERMIT APPLICATION EVERETT 82 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 i(E)everettepsceverettwa.gov 1 www.everettwa.govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: 2310 grcra3cli BUILDING AREA:. 5oo sq ft PROJECT TYPE: El NEW CONSTRUCTION DI ADDITION ►':' TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS; COMMERCIAL ELECTRICAL APPLICATION INFORMATION St DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ WO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: qori LA) re, rrojA Lee Or q .. r e, i, ,, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 121 NO 0 YES-Select Scope:❑Service 0 Feeder ❑Circuits-#: El Complete Rewire LOW VOLTAGE WORK? 0 NO YES-#of Devices: I SELECT SCOPE(REQUIRED):0 Data 0 Intercom ❑Thermostat CI Audio 0 Secure Access liaSecurity 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. 0 Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO ❑YES--See Below&Pg.2 E["�"` 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: INC EYES-See Below&Pg.3 - Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sate,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; 4,, . Sa6eA.,1TENANT BUSINESS NAME(If Commercial): eJers,6vs OWNER MAILING ADDRESS: STREET ,d ,\ crTv #. i, i STATE d ZIP 14/45 OWNER PHONE: a5 . d " Sc2.2, OWNER EMAIL; CONTRACTOR NAME: ( , , 'Lon 'IX, CONTRACTOR ADDRESS: STREET ` ,i t` '. It CITY �u 4-, : STATE zw CONTRACTOR PHONE: 5.4 2YO3( CONTRACTOR EMAIL: 44 Si C f ,Y ,-,/ ,C#3M CONTRACTOR LIC.#(REQUIRED); _; !CITY OF EVERETT BUSINESS LIC.#(REQUIRED): '31.2/0 PRIMARY CONTACT: 'DOWNER ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ig 5 -go 2 _wax, t t l CONTACT EMAIL: r ,,, yr AGREEMENT.I hereby certify theft have reed and examined this application and know the same to be true and correct. Al)provisions 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 lam 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 WAG. City of Everett Official Use Only PERMIT#: -r\-. . - t E \°l Di- 05(0 OwnertA zecrAge gnature Date (Revised 111V2019) Page 1-Application