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41, • <br /> ELECTRICAL PERMIT APPLICATION <br /> Apo_ <br /> !,7404.7" ciTy OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteptiftemattwagov www everattee.goviperrnits <br /> frnifigrw:i"-= <br /> PROJECT ADDRESS: 31-12S" coLE14 Ave BUILDING AREA: sq ft <br /> PROJECT TYPE: 13 NEW CONSTRUCTION 0 ADDITION 111 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: CI SFR 0 TOWNHOUSE CI DUPLEX El ADU MULTI-FAMILY OF UNITS: 0 COMMERCIAL <br /> L;tr,P;I:..tt • ° <br /> CONTRACT PRICE OF WORK:$ -71 oo ASSOCIATED BUILDING PERMIT if(if applicable): <br /> DESCRIBE SCOPE OP WORK! /2..EPLAct fax. Aavt," <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO DYES-Select Scope:0 Service 0 Feeder ta ConOats Re-wire <br /> LOW VOLTAGE WORK? C1 NO NI YES-#of Devices: 33 <br /> SELECT SCOPE(REQUIRED): 0 Data 0 intercom 0 Thermostat 0 Audio CI Secure Access CI Security System <br /> 14 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additionai <br /> Fire Alarm Permit is required for review of device location and installation approval <br /> E3 Other(List Ally <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: '74 NO m YES Sea Below&Pg.2 <br /> E3By checking this box,I am stating that I have read and understand all of WAC 2$6-4613400,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the folkming sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:S4NO DYES-See Below&Pg.3 <br /> DPursuant to ROW 10.28.251,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> see page 3 signed the AFFIDAVIT on page 3 of this application to receive en exemption from this licerleing/certifiCatien reqUirernent <br /> < < <br /> OWNER NAME: nvvitaerviv view caocx, Holdi TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: MEET 342c 401.534 vL7 <br /> cirr v42T1 STATE WF ap8 ) <br /> OWNER PHONE,: OWNER EMAt <br /> CONTRACTOR NAME: a Ft at". <br /> CONTRACTOR ADDRESS: STRfiET Pc a Olk 3711 <br /> AR-'-IcoJ STATE, vulk BP 9'8223 <br /> CONTRACTOR PHONE: LfZ.5 24LI P-/I4S CONTRACTOR EMAIL: f C is)H trAC.. cor--N <br /> CONTRACTOR LIC.IhRtouIRT): 1 f R.1i F JL ) 'CITY OF EVERETT BUSINESS LIC,SVISOUIRED): .01.516-) <br /> PRIMARY CONTACT: DOWNER NI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: J'f2 VIL/ )1.'95' <br /> 13flossAizo CONTACT EMAIL: --z-e,F )3thj <br /> UPtiilEatga I isereby cartity that Ihave read and eXtijaffedihis appkeatten and know the same to he true and coirec. Alt provisions oftws and ordinenses gown*:ta$ <br /> type Grew*ell/he completed whether speteled hen ikt or noi The granting eta awn*does not presume to -give*Mho* kikitsts or ciumei the provisions of any otherstete Or <br /> Wei ieW regulating construction or the partormeme o sonstruction hat em authorized by the own ere,rhos property to perform the work tor*Inch apptication is made and t <br /> comply with the State Contractors Law 1827 RCW ene 296 200 WAC City of Everett Official Use Only <br /> PERMIT <br /> iteizolA E <br /> Owner/ rad Agent Signature Date rt.:jeweled/if MON Page 1-Application <br />