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teECTRICAL PERMIT APPLIATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WA{NINOTON (P)425-257-8810 I FAX 425-257-8857 I(E)overetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT ADDRESS: 3CO3 W, CASJI\(C ROAD (BUILDING, REf's- '10-5?o CDC.% <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION III<NANT IMPROVMENT ❑ REMODEL / <br /> BUILDING USE: ❑SFR ❑y TOWNHOUSE ❑ DUPLEX ❑ADUy ❑ MULTI-FAMILY9 -#OF UNITS: 7 COMMERCIAL <br /> -.E - ta._;J.VF .�,.•,1 r, .. sir .B A_I Iv. 7(.0 . i'1 �. P3.1:1f:51_8 C'; r 11.f ! .eta?' Al ci�_'1 <br /> CONTRACT PRICE OF WORK: $ 5 / avp ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: p_---pLAcE LIGNTtt.LG Fax-"N - AnCD p'wt <br /> Fr:92 AcUTONIP.iICU DIE CLEP0.i1S- MACIA , <br /> SE�2•.l0� 4- 65 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 1--1:.!1'NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑ Circults-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? .'NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System <br /> ❑ Fire 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. (4) L/D <br /> L 2'Other(List All)(8)L )GEthkr t5,vm '(24)T8 FLfiogesc JT L.th q (f4'UPS; <br /> icy°l°�., I c7,Y 1v ..:._ <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I NO ❑YES--See Below&Pg.2 <br /> I By checking this box, I am stating that I have read and understand all of WAC 296.46E-900,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 following sub sections that do not <br /> See Page 2 require Plan Review. tttt� <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURFO EYES-See Below&Pg.3 <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on uildings 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 an exemption from this licensing/certification requirement. <br /> C;',l[I IVi r:.i r1 .0 n G <br /> OWNER NAME: 7 e,AJG CoMPAIVy• TENANT BUSINESS NAME(If Commercial): ,EOE,►.IG <br /> OWNER MAILING ADDRESS: STREET 7) gox 37o7 <br /> CITY STATE WA- ZIP 9e/z4-Z107 <br /> OWNER PHONE: x)/A- OWNER EMAIL: ✓i./ft <br /> CONTRACTOR NAME: oS€QUO//4H EZ c rfraiC/ LLC <br /> CONTRACTOR ADDRESS: STREET /5/35 NE qZ /&/A TY--EET <br /> ^� <br /> crrY ��MDi, N STATE WA ZIP 38O52- <br /> P12-LJECT N IC7R. <br /> CONTRACTOR PHONE: i.Z5.6!'4 (oCm GON-T 9R EMAIL: 9.14--- . erg cc_ j, Corn <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSS LIC.#(REQU RED): <br /> PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425, )L29 Z5-15 <br /> / <br /> -EMPctJ CONTACT EMAIL: j ,a,a`id ,5c - 0 <br /> A GREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisi s of!ads and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application Is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 8_�q./9 E k,c(0� -- (g <br /> Owner/Authod Agent Signatur Date (Revised 1/11/2019) Page 1-Application <br /> UUU PP—a-ICCT Cov;e13/iUA7D <br />