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ilb 0 <br /> CITY OF EVERETT PERMIT SERVICES <br /> .744 -1 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 1 <br /> PROJECT EITE:iNFORMATic). .. • <br /> PROJECT ADDRESS 300� �‘) C .`;,.5, ) 11 __/9� (BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION !I ADDITION Ii TENANT IMPROVMENT II REMODEL <br /> BUILDING USE: 0 SFR ®TOWNHOUSE ® DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: COMMERCIAL <br /> : ELECTRiC. CA'TiON tNFPRMATI®M 8� DE ig$0glir OF:1001 C , <br /> CONTRACT PRICE OF WORK: ? 2 G22) ......)1ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: ,T/l.� L/�,/ f (-0,--) Irc/!S <br /> c?, ct t LkD -- 4 ( er < < <br /> ator .S /% 7 4 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> ®Service 0 Feeder 0 Circuits-#: ®Complete Re-wire <br /> LINE VOLTAGE WORK? !WINO ®YES-Select Scope:LOW VOLTAGE WORK? 0 NO El YES-#of Devices: 7 <br /> SELECT SCOPE(REQUIRED): <br /> ® Data 0 Intercom 0 Thermostat 0 Audio ®Secure Access 0 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. <br /> ®Other(List All): <br /> C.i30E...COMPLIANCE" ; <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: igil NO 0 YES--See Below&Pg.2 <br /> ® By checking this box, I am stating that I have read and understand all of WAC 296-46B-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. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 1-NO DYES-See Below&Pg. 3 <br /> ® Pursuant 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 /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> COls TACT.INFORMATIOi+i. . : .;_ <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: (OWNER EMAIL v.w <br /> 7 <br /> CONTRACTOR NAME: z^ i( -c C(✓)L-e_ <br /> CONTRACTOR ADDRESS: STREET 0667 J. 2 `((!/1 5 r <br /> /yam .' -7 <br /> CITY /th- STATE (�'�L+�'J C <br /> CONTRACTOR PHONE: 2-06 3 L i 52 3 l./ CONTRACTOR EMAIL: fGllap1 cI (2 hrev�cve, .e(t'(/(t( f (4 1 <br /> /� � 7() CITY OF EVI3RETT BUSINESS LIe#(REQUIR : `'00-23 <br /> CONTRACTOR LIC._ ., #(REQUIRED): V ��'��W] �..., , �..... , .s>r ;, <br /> PRIMARY CONTACT: 0 OWNER a ONTRACTOR ❑OTHER(Please Specify) <br /> — <br /> CONTACT NAME: CONTACT PHONE: 2,i6 `5 2 / 5-2,5'7 <br /> LeTt1 t ( (/ CONTACT EMAIL: ��G_�1 7 i,r'i(/t,f/c'��YY'y//y,�((l?(1rILG),cfe: 11 <br /> AGREEMENT:hereby certify tha I have read and examined this application and know the same to be e t u t andcorrect. <br /> rrect. All <br /> lity lo o lionslate of Iaws n el theordinances <br /> s any other verning state or <br /> is <br /> type of work will be completed whether specified herein or not. The granting of a permit does p 9 <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work <br /> r for <br /> Ewhictt Oplic atil n s made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. CitPERMIT#: <br /> .3 —/.— % E '1li'0 11 (Q 1 <br /> wner/Authorized A ent Signature Date (Revised 1/11/2019) Page 1-Application <br />