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0 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA SWI <br />(P) 425-457MIO I FAX 426-257-8657 1 (E) evotettops@waremva.gov I wwwoverottwo-go tperrrb <br />PROJECTADDRESS: Z►T SW ZvsRt;3T FALL 1'va BUILDING AREA: it <br />PROJECT TYPE: Q New coNSTRu T" Q ADDITIONM TENANT IMPROVMENT Q REMODEL <br />BUILUSE: El Q TOWNHOUSE Q DUPLEX Q ADu Q MULTI.1 AMiLY . # OF UNITS; COMMERCIAL <br />MG <br />CQNTRACT PRICE OE' 1A1Q1tK: S 35 00 "^ AS$OGIATED BUILDING PERMIT # (if applicable): <br />DIEt RISE SCOPE Of WORK: f-)RW ALA2-. i-votf 4ATivN Ft4L &_AANOGj> SJAQwrtoLN" NtifvV <br />pff iL�tS Aa.�D B�"iNt2vt�w+S _ <br />T1418 INSTALLAMIN 114CLUDIES THE FOLLOWING SCOPE- SELECT ALL THAT AP" <br />LIME VOLTAGE WORK? _VNO Q YES - Stud Sc (3-service QFeadwr Q (:ircuits-#:... Q Cornplete ft wire <br />LOW VOLTAGE WORK? Q NO _�M YES- # of Devices-, 1) — <br />SELECT SCOPE (REQUIRED): Mate Q intercom Q Thermostat Q Audo Q Secure Access Q Security System <br />Fire Alarm - Intallations uncler this permit only include electrical wiring rough -at of the system. An addirionsi <br />Fire Alarm Pert Is required for review of device loci and Installation appram_ <br />Q Other (List Ali): <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: NO E3 YES -- See Bellow s Pg. 2 <br />By dmddng this box, I am stating that I have read and ur rstand all of WAC 8800, selected the specific reason on page 2 <br />13 <br />of this SWIt ation (see next page), AND Plan Review is NOT required because i meet ail of the following sub sections its do not <br />Sees Pop 2 !!,"re Plan Renew. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO YES -See Below S f'g. 3 <br />Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform eiectriml work on buildirvs for runt, sale, or lease <br />without the proper electrical licensing and cer'ttEication, or exemption. BYcheddn this box, I am stating that I have completed and <br />See Pays 3 signed tt* AFFIDAVIT on page 3 of this apiaitcation to receive an exemption f -om this licensing/ tiflcation requir nt, <br />,x <br />, `� n.+ v" yak •, <br />.. ,;;. <br />WNER NAME: a v-ErA&-" Ri­?C-tz5 PoR35 TENANT BUSINESS NAME If Commercial <br />OWNER MAILING ADDRESS: WREST 715, S W eiricn.:.717 ►"`A t-L- WA <br />city GvttLL 1-T STATkWA zV zjv <br />OWNER PHONE; <br />OWNER EMAIL: <br />CONTRACTOR NAME: 134,H f 1IRE <br />CONTRACTOR ADDRESS: WMEFT Ra Box 37 }t <br />orrY Aa.L 1 N i^,y Lw STATE V_;1A zip 9TV2_Z 3 <br />CONTRACTOR PHONE. 47-5 -244 144 <br />CONTRACTOR EMAIL: -Siff EL BNHI-IR-: _Ctlw- <br />ONTRACTOR LIC, REQUI 13N f 12N f $r1 Z <br />CITY OF EVERETT BUSINESS t_iC. RE0UlrZEla : 4.5•4'17 <br />PRIMARY CONTACT: © OWNER __�M CONTRACTOR d OTHER (please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 4 �?, 244 14%4 <br />CONTACTEMAIL: �Gp �N rf2t Lc�+r`t <br />t1:f FritzuSSP1Z� <br />AGREEMENT: r h**bY CWW that I hav0 mad aw e­ft*W 14n18 appSaS W Wd knoW the 39MO r0 be !tire 300 OMM. AN pr4vrar M Or taws WW MManca s WVWMW uus <br />typo of woo* vAf be c mpW&d wrtWhw specftd hwa�kt or twr. The gtw*V ors pout* nor presume to otm samoroy to viotaai or cancel the pravtsfons it aw oilier vate of <br />kicat hew reouWM conertr cWn tv rhs pertamwwo of coWnictva rhat t am au#Otzwd by do owner of that p r porty to podorm the ►ox* for whk h apphcahwi is male and I <br />my 3W%O the .State (irNlfralbr1 Law f8,27 ACWwrd 2M.200WAC Ck of.t1vorett Official ties Only <br />EEE� <br />Authoriabad Agent Signaituru Data vised 1/1 1 1 J Page i Applicration <br />