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�yF ELECTRICAL PERMIT APPLICATION <br />OFEVERER PEPERMITSE W <br />33MCEDAR f1w S1REa K ERErt98201 <br />m. WA l%10 FAX an, <br />ovl �' 1 <br />PROJECT SITE INFOR "ON <br />PROJECT ADDRESS: i ion, <br />BUILDING AREA. agi <br />PROJECTTYPE: D NEWCONSTRUCTION EIADDII ❑TENANTIMPROVMENT RREMODEL <br />BUILDINCUSE: ❑SFR ❑TOWNHOUSF ❑DUPLE% ❑ADU ❑MULTI -FAMILY -f OF UNITS 1 ❑COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION A DERCRIPTION OF WORK <br />CONTRACT PRICE OF WORK:3 ASSOCIATED BUILDING PERMIT 9 if appLadel IF W i I O <br />DESCRIBE SCOPE OF WORN:- IJi I ,ai v+_..+.YA <br />fnw. clK.a <br />kSal0.• 1 <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORN? NO ❑TES-Sebtl Smp. O Servlw QFeeEer DCItolroa._ OCanpkM Re•nin <br />LOW VOLTAGE WORK? MNO ❑YES-Yo1 NvY <br />SELECT SCOPE IREOUIRER 11 Data ❑ Inlelmm ❑ T4erani ❑ Aldm ❑ Seam Mmv ❑ Seventy System <br />❑Fin Alaml-Involations under Nis N mul only Indeed ekMcalwnlg mul of tM system An eWNwnal <br />Fire Alalm Perot 9 RguilN for review of Eevia loaean and inn Allmon a[pWal <br />❑ OIMr(Last AIL) <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION.IN$TITUTIOIWL. HEALTH ANDIOR PERSONAL CARE FACILITIES: Duo YE5-See Belawti Pg2 <br />�I By cartel this GY, l am slating that l Have read and understand all of WAC Stfi-0BB-900, selected due shal Mason on page <br />u of Utluppllutlon(seenertWPeL AND Plan Removers NOT rebored Cewuse l meet all ofttie fall sub demons l detoo not <br />Sae Pagex Irywie Plan Rend <br />ARE YOU AN OWNER PERFORMING WORK AS THE COMPACTOR WITHOUT ELECTRICAL UCENSVRE CINO HYES -See Below S Ad <br />❑Pursuant to RLW 192E 2B1. pmltay owners and leaseholders annul pedomelectrical work on buildings torrent sale of lease <br />o wOouUMOoparala inGl had ing and consficinton afferemption.Bycdechngldisbox l amstaunginatlbavacompletadand <br />Sus Pai 31gMd the AFFIDAWT on page] of this application torewiveanexempbonlmmlfiuewngmglwNfiwuonreboremem <br />CONTACT INFORMATION <br />OWNER NAME: Plr 1 In TENANT BUSINESS NAME Il Cwnml: lar <br />OWNER MAILING ADLiUdil st 1 nd'unA,Pt $ ebt,li, <br />n Iva., 9 i r 3 <br />OWNER PHONE:\r-I 25 -LDS°C' <br />OWNER EMNL: Yv. rva fr r. a1H alm0e teo- <br />CONTACTOR NAME: P" <br />CON CTOR"DREM SurnalSTATE <br />LP <br />CONTRACTOR PHONE: <br />CONTRACTORS L: <br />CONTRACTOR LIC. NREOUIREop. - LITT OF EVEflETi BU51XESSlK. OUISIED) <br />PRIMARY CONTACT: WNER 000NTRACTOR DOTHER(PWa Spe ) <br />CONTACT NAME: CONTACT PHONE: (4L5)'rnj (y-inDi Ja <br />r..;9Kf QhI•i�KY CONTACT EMAIL: 1 C a .sOm <br />AGREEMENT I Mney a Ml AM road and e•anvpi mu apµ'Im any new day teas b an Yve As mn4N XaYNaJmba something For <br />fryeMws M'bmr¢MNrifsYwgsAsd liwonrwnol TM Patti <br />i... assume <br />an on" <br />lopat ent in mmeWavod MPwbuylarrycNV ndI <br />bw rtpNbq¢nmumrnpp27RCAVol 296Wttwn T amaulnomNoylMwnerolP so, to NrlwmMvabsltlraq'IaYn YnMa WI <br />amay.Yln. $x con.Py..I.ra tea Rcwamme zw vent a cI aEa..sa$mYIA. <br />PERMITt <br />/IIh, EWtlmv <br />O UA t Agent SN^ m a ( - wrissi OxM Pap fJPPb <br />