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<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 88201
<br /> (P)425-257-8810 I FAX 425-7.57-8857 1(E)evetetteosIgeversttwa gov I Nwwv everattwa.covrperinds
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<br /> PROJECT ADDRESS: 2707 C61-5Y AVE Esi u ft
<br /> , E 37-6. "1 so t UILDING AREA: sq
<br /> PROJECT TYPE: I:3 NEW CONSTRUCTION CI ADDITION TENANTIMPROVMENT 13 REMODEL
<br /> BUILDING USE: 1:I SFR CI TOWNHOUSE 13 DUPLEX CI AOU CI MULTI-FAMILY-#OF UNITS' litCOMMERCIAL
<br /> .1,-,\--at,A:- . s,. r --••-i 'V.: 1, Amp ---''• "", " , '%•,131 • , ,k ‘..'4 AC"' -'$Rilt .;-,A4'7-. --,..• .4'''s1,::_7:,,...-4 :,1„4.1:11K4 ' -::,4 i,..k.0„. `',....' it.,.. = wi, . . 'Ai.4' `,:*4 '. '''• .-- -.4.4.,441,41,4,-- 0. -jsi, -., t ;,-;4,, .,; ,.. .
<br /> CONTRACT PRICE OF WORK:$ 2 f 1 CO ASSOCIATED BUILDING PERMIT 11(if applicable).
<br /> DESCRIBE SCOPE OF WORK: Rd. 4 rallinliMA 111=11161( . I i
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<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY)
<br /> UNE VOLTAGE WORK? NO DYES-Select StTe:C3 Sendai 0 Feeder CI Circuits-a: CI Complete Remke
<br /> LOW VOLTAGE WORK? El NO ITYES-#of Devices: li ,
<br /> SELECT SCOPE(REQUIRED): CI Data C3 Intercom 121 Thermostat Cl Audio 0 Secure Aczess CI Security System
<br /> 126ire 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 /> 13 Other(List my
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH MID/OR PERSONAL CARE FACILITIES: NO YES-•See Below&Pg.2
<br /> EtBy checking this box,I am stating that I have read and understand all of WAC 296-46E400,selected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review Is NOT required because I meet allot the following sub sections that do not
<br /> See Pegs 2 require Plan Review.
<br /> ARE YO AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO EYES-See Below&Pg.3
<br /> EiPursuant 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 /> sett page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement
<br /> we' ,
<br /> OWNER NAME: "DK-11 A , 1 TENANT BUSINESS NAME III Commercial):
<br /> zOWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Yrk Fire. 4- curl
<br /> CONTRACTOR ADDRESS: STREET PC) BOX "-.111
<br /> CM Pirtiy-tc\--Ori STATE w A z , 12)22.3
<br /> CONTRACTOR PHONE: /12. -2qq-it1961CONAACTOR EMAIL: )efffop i%iifjrc.. . COfY1 ,,,d4.-t
<br /> CONTRACTOR LIO R(TISOUIRED)zglArie?--)41.:::ta q IcW law OF EVERETT BUSINESS UC,STREOUIRED,): 01010 W 1 I
<br /> PRIMARY CONTACT: 0OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ,.../ CONTACT PHONE: 142.C.D . gqg icfc(
<br /> )e,W 51/665011C-1 CONTACT EMAIL: )ef.p,..i& EN J-.),F(rc . alell
<br /> iteREEMSVil/a/v*6y wilily-that t haw mad and examined application and know the soma o ha trim and corm, 'proWatans°flaws and ordinances goysiniso this
<br /> typo a t work*tile aomplated whew specifrod ntimin or not. ThO granting eta permit does not prows*to giVe authority to Wds tv or en muffins provisions of any otharatata or
<br /> local law none*cons! inn or tha partormanas el continuation That!runinoinorind by the otawar this plops*to palatal.Ms%oh<kw which application is muds nod!
<br /> comply with the Si /tractors Law 11127 fiCW and 290' WAC / City of Everett Official Uee ratty
<br /> PERMIT ft.
<br /> Authorized Agent S melee Date Nevised fir I/20/0 Page 1-Application
<br /> F4 P%(7111CD... 71Le'
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