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<br /> ' #401P ELECTRICAL PERMIT APPLICATION
<br /> art OF EVERETT PERMIT 8ERViCE6
<br /> 4004.'0,771,., 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (Pi 425-25t-ab1e I IAX 426-257-8661 I(E)everefoos@evervillwa goy I wviev.evereliwaniwitiennits
<br /> ,. .,-.7'' - '''•, „ - ! ., , ' ,11,t1E91C1C01-*:''''''
<br /> PROJECT ADDRESS; 220 Z. )0 0 T ti 5T $1.0 IBUIUMNG AREA; so ft
<br /> PROJECT TYPE: Cl NEW CONSTRUCTION CI ADDITION A TENANT IMPROVMENT Cl REMODEL
<br /> BUILDING USE: Cl SFR CI TOWNHOUSE CI DUPLEX Cl ADU Cl MULTHFAMILY-#OF UNITS: COMMERCIAL
<br /> CONTRACT -
<br /> 4``''''''l' '41114414111141;4APSIIStiAillOtiannigiklit?it '-• ' o,,„ts',':<,-PAI 4,t,--;..-
<br /> CONTRACT PRICE OF WORK:$ 4 100 G---t- ASSOCIATED BUILDING PERMIT*(if applicable):
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<br /> DESCRIBE SCOPE OF WORK: -1*.AjAArr )1t)1 c42, Our Of OfP/C.,E, NatA ,
<br /> . . ..,.. ,
<br /> : .
<br /> - . .
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY
<br /> \. UNE VOLTAGE WORK? A NO Cl YES-Select Scope:0 Service 0 Feeder Cl Circuits-ft: Cl Complete Re-wile
<br /> LOW VOLTAGE WORK? Cl NO YES-#of Devices 7
<br /> SELECT SCOPE(REQUIRED): Cl Data Intercom Cl Thermostat 0 Audio Cl Secure Access Cl Security System
<br /> Fir Alarm
<br /> Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additiona,
<br /> Fir Alarm Permit is required for review of device location and Installation approval.
<br /> ci Other(List Ail):
<br /> , •.;.---•,,,,;"1,4,4-,....?,;;;,,.5,,,,,
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES; 4 No U YES-See Below&Pg.2
<br /> DBy checking this box,I am stating that I have read and understand all of WAC 298-46B-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: Nig{61:EiT:See Below 8 Pg.3
<br /> EJPursuant to RCW 19.28.261,property owners end leasehoklers cannot perform electrical work on but iivs 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 /> gee page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement
<br /> . '
<br /> OWNER NAME: Aul-PoRT )00 L.LC- TENANT BUSINESS NAME(If Commercial): -roor,ix...36 mfisric
<br /> OWNER MAILING ADDRESS: STREET Po acnk )2143
<br /> etre A Orw,1005 STATE WA ap qtro20
<br /> OWNER PHONE: 2Q6 l,to b 3 43 3 OWNER EMAIL:
<br /> CONTRACTOR NAME: 1311.14 tell:.
<br /> CONTRACTOR ADDRESS: smut Pe
<br /> cw gilt iNt-lon) STATE NA.A ZiP 6%4621.3
<br /> CONTRACTOR PHONE: LIZS". 21444 igt45... CONTRACTOR EIVIAIL: "Scf f CP.. SO 1-if iftt„,
<br /> CONTRACTOR LW, -EQUI- : 'N.Ifliz-.1A Ft3t12400.) CITY OF EVERETT BUSINESS LIC,ffillEatilRED):
<br /> PRIMARY CONTACT: 0 OWNER )ti CONTRACTOR ID OTHER(Please Specify)
<br /> ,,----
<br /> CONTACT NAME: 'CONTACT PHONE: Ji 2.5- 24 LI )14-Li 5
<br /> •--- eTs "8,24)seiv2 CONTACT EMAIL: - b-:ff ( ) !I-AZ.CO,Y7rN
<br /> AS4E410171 I i;ereby cmtify that I have read and examined this applaatiori aadPlow The same to be true and Gone AO provisions+Wawa she ordhlwices governing this
<br /> typo c,1 work will be completed whether specified herein or not The Tenting eta permit does not presume to QM authority he violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That!am nottiorized by the owner of this property to perform the work for which application is made and!
<br /> comply With the Stet tractors Law 18.27 Ft'CW and 296.200 WAC 2.1.1 of Everett Official Use Only
<br /> PERMIT#:
<br /> ' ?./. ' ) /20Va- E TIDs---.( (02-
<br /> Own uthorized Agent Signature Into (hevised 111112019) Page 1-Application
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