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Apr23 19 01:54a Bob Jack S096746777 <br /> p.1 <br /> 1111 <br /> • <br /> ECTR C L PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE1 1,WA 98201 <br /> �� yp' everettvda.gav 1 www.everettwagovfpermits <br /> (P)4t 257-8$30 I FAX 4«257$857 I(E)evefettepsQ ._ <br /> �/^ ,� ,�y BUILDING AREA: so ft <br /> PROJECT ADDRESS: L1�J 7}(� cc',er r AI �N <br /> PROJECT TYPE: �NEW CONSTRUCTION le-- <br /> cNAN IMPROVMENT 0 REMODEL <br /> CONiMERCIAt <br /> BUILDING USE: 0 SFR ®TOWNHOUSE ®DUPLEX �ADU 0 MULTI FAMILY #OF UNITS: <br /> ELECT'R VGA` cPPEmllCA'711,147E+,IFC?Rlrf#•1'I'dAN DES R1� �01+I �F- O i <br /> CONTRACT PRICE OF WORK:$ /(' ‘P� <br /> [ASSOCIATED BUILDING PERn,IIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: /N6f bll 1 LEA L't 11/AA <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) Complete Re wire <br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: ID Service ® Feeder 0 Circuits-#: <br /> • <br /> LOW VOLTAGE WORK? 0 NO ES-#of Devices: - <br /> f� ®Secure Access ®Security System <br /> SELECT SCOPE(REQUIRED): �ata <br /> Intercom ®Thermostat 0 Audio <br /> I <br /> 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 Iccat'ion and installation approval. <br /> ®Other(List All) <br /> 00111 G.ON1R' 4.14.0 ; .M:3, ,tom: - A <br /> CILITIES: NO YES--See <br /> IS THIS PERMIT <br /> El Ey EDUCATION,thisbox,IN I am stating I have read HEALTH Dar'.R.d nderstand all of WACERSONAL CARE A296-468 900,s acted the specific reason o cm page2 <br /> oy checking thissonI am g <br /> of this application(see next page),AND Plan Review is NOT required because 1 meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER to R PERFORMING 61,propertycw erE rs and ass olds s cannot perform electrical wR VVITHOUT ELECTRICAL lSURE; dicirD OYES-See ork on buildings for rent,sale,orllease Pg 3 <br /> Pursuant <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 /> : '`EO.N17..4.P7 ;Ik[1FORlYfA ION .: - i. , ,r: . _. <br /> OWNER NAME: ,(elf <br /> -TENANT BUSINESS NAME(If Commercial): 1^•--r—{.N, 0114t e..ta'c.it <br /> OWNER MAILING ADDRESS: STREET . .."3n CeJ-P t- c- L.o 'ILIA, <br /> A �p cI�/ <br /> GrrY ��Y`el e STATE l J , ZIP Si'f <br /> OWNER EMAIL: - <br /> OWNER PHONE: --.. <br /> CONTRACTOR NAME: U YL'OVS eD -C--i--- Ze,`.1 ti . <br /> CONTRACTOR ADDRESS: STREET <br /> r n J STATE e, ZIP 7 - 2 _ <br /> • <br /> CONTRACTOR PHONE:4 ' —j 47'3 b IfsONTRACTOR EMAIL: g I a 6tilt45(2, , - ` CinLam. <br /> CONTRACTOR LIC.#J{REQU1RcO): <br /> [CITY OF EVERETT BUSINESS LIG.#(REQUIRED): <br /> ,.._ -__.. _.-_ , ._ ... <br /> PRIMARY CONTACT: ❑OWNER *ONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE cef - L'D 1 5-q <br /> CONTACT EMAIL: R �,�' k P 1/Vt a L -cC- 'c...c k <br /> is <br /> AGREEMENT.J eby i(y that l ha r de read herein to d ovisions any laves and ordinances governing or sot. The granting of apeto perform the work for which application is made and 1 <br /> local law rage- ling construct R or the performance of construction. That 1 am au(rorized by the owner of this properly P Clty of Eve rett Otfiaial Use O n 11� <br /> comply with f e State Contra tors Law 1 27 ftCNfand 296.200 WAC. PERMIT#:y r `OwnerlAuth lz Agent Signa e Date (Revised 1l19l2019J Page 1-Application <br />