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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WA6NINOTON (P) 425.257-8810 1 (E) PermitServices@everettwa.90v I vAvW.evereltwa.gov/perrnits PROJECT SITE INFORMATION PROJECT ADDRESS: I (✓ 4C t !� BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION TENANT IMPROVMENT []REMODEL BUILDING USE: ❑ SFR [:]TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: McoMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 2 �� •- - ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Jam' j ur c� � Se k(i+%. a KC Is r .1_ r' (��K ►1 rCwtOv CCur-r arl�� rt �qC�� Cd. - ` o, t 1) r- Q 6D :+1 ale Lie - THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO YES - Select Scope: ❑ Service ❑ Feeder 0 Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? E9 NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Sectire Access ❑ Security' System ❑ 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. ❑ Other (List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL- CARE FACILITIES: LJNO YES -- See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand hll 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: NO ES -See Below & Pg. ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, c)r 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 �rr OWNER NAME: f'Gv t `do t el- AL Lp'c"el A ( '`TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET I e Ok LI ,d 4, � �f� * /O' 4 CITY e ` 7n STATE WT-T 21P �� 5 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: U r CP{CCF� ` I < ►lolo% Z `� �' L L CONTRACTOR ADDRESS: STREET _tLf S r 1 L� (y CITY S (&W STATE W r r 21P ` 6! Q C3 CONTRACTOR PHONE: 20(P -�{3(e - 5L60 I CONTRACTOR EMAIL: CONTRACTOR LIC. # REQUIRED : V F C-A F-- T Q, 2. (O Q ICITY OF EVERETT BUSINESS LIC. REQUIRED : OOL4 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OOTHER (Please Specify) 1Fi-LACt w(2( �+rt...a�'► CONTACT NAME: =�(M '�t pl c1 wl,( C� CONTACT PHONE: ?p _ Sd•- cj g CONTACT EMAIL: AGREEMENT,/ hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing ruts type of work will be completed whether specified herein or not. The granting of a perrnil does not presume to give authority to violate or cancel the provisions of any other stafe or local law regulating construction or the performance of conshuction. That tam authorized by the owner of this property to perform the Iwrk for which application is made and I comply Iith the State Contractors Law 18,27 RCW and 296.200 WAC. City of Everett Official Use Onl _ PERMIT #: V ? ,- E 2207-168 O ner/Author ed Agent Signature to (Revised 41512022) Page 1-Application