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L. <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY of EVERETT Purr saEf{vr,;i=_� <br /> EVERETT =CIMAx STREET EVERETT,wit 982014PI r•25l5�EE74 l iEt PGnTd5WvW&5Qeverc-3 qav 1 www"Woltwa 0"Parrr" <br /> «waw�w9nfr <br /> i - 1f- BUILDING AREA �I <br /> PROJECT ADDRESS: IG 1 R <br /> PROJECT TYPE: D NEW CONSTRUGTTON ❑ADDITION ❑FENANT IMPROVMENT REMODEL <br /> 13UILDING USE. [7SFR ❑TOWNHOUSE ❑DUP<Flt ❑ADU ❑MULTI-FAMILY-Al OF UNITS- <br /> ELECTRICAL <br /> NITaELECTRICAL APPLICATION INFORMATION & DESC IPTlON OF WORK <br /> CONTRACT PRICE OF WORK: i - f (ASSOCIATED BUILDMG PERMIT M Irl aWhcablel / J <br /> DESCRIBE SCOPE OF WORK: v L C-'t L A-_WI rt sevy� <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: JSELECT ALL THAT APPLY) f, <br /> LINE VOLTAGE WORK? ❑NO [@VES-Selea�Scepa_0SWVW6 ❑Fe_�ster ❑G�r� ` � (6 ❑ContpFe­Re-wlie <br /> LOW VOLTAGE WORK? CQ NO ❑YES-0 of Detigm: <br /> SELECT SCOPE(P£OUiREDI Data ❑Irttetcam ❑T1,,em ostai ❑Audio C]Secure Aces ❑Securty rgy%err+ <br /> ❑Fire Alarm-Installabons under this permit only include e4ctncal wrong rough-in of the syslem An <br /> additional Fife Alarm Permit is required for review of device tocnt►o.1 and rn"latlon approval <br /> ❑Other(Ust AM). <br /> Ili THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES. NO YES-See Below& Pg 2 <br /> By Checking this box I am st-anng teal I have Tead and un4erstand air of WAC 296.468-500,satected tta specific mason on page <br /> 2 of this appllt:atlon(soo nottt page) AND Pian Review is NOT requued because I meet all of lite follQrnrtg sub secimns that do not <br /> sora Page 7 require Pian Review <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LtCEfiSURE: O S See$clow S t' <br /> Pursuant to RCW 10 26 261 property owners and leaseholders cannot perform electrical work on buildings for rent,sale or lead <br /> w0hout the pruper electrical licenst•.►g anti r nnf;ratton,or exemption. By ctoecltinq this box. I arn stating that I have completed and <br /> Fags 3 signed the AFFIDAVIT on page 3 of this application to receive an exernoon from thta I rts,ng/cerfificaiton reQtnremeftt <br /> OWNER NAME jt TENANT BU3tNESS NAME (lf Commercial) <br /> OWNER MAILING ADDRESS: <br /> :t. -A 7- Win • 5 <br /> OWNER PHONE: OWNER EMAIL- <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTtt <br /> ;;4r <br /> CONTRACTOR PHONE 6 -3 N 4015 CONTRACTOR EMAIL: S Q 0 0_ <br /> CONTRACTOR LIC-M!P.EOUMEO): CITY OF EVERETT 13USINVU UC.111rR£411r <br /> PRIMARY CONTACT: gOWNER ❑CONTRACT(-)R C]01 HER(Please Spetfy) <br /> CONTACT NAME: 74&n7otel l/ CONTACT PHONE: _ 3„y-y0gS <br /> CONTACT EMAIL. AsratJO -1•ulha <br /> 4r-4rF E T hero0)artif}t alar I Hove rear a.•a a amme7 dua aap4rzbm and kmry w the ams too true and mrFea rovi20"OI Iaurr.and wdMww'n parwmv do <br /> tree at WCA MW 6!Cve�llafsd NfeelrMF vacrr�nefmn or rqf Tne arw 4nv ale pomf 6-nor Presume b give e:�fhor+y fo YlarB10 or tsntet the pravcsions d eny allm (tele <br /> d'Ctt<iow+egeteEn�oartafruchoa or tt►e perlurrrvrA;s d COIt3trr•'L'3An Tltef J oro autharrzed by hrr pwy_r d ff+!s property t�psri6rrrr New wws b►wht17 opp4caem+ e rr+eds ar!a I <br /> cgpWtyy with rhr Store C rzactaa taw to27 RCW aW M 200 WACof Ematt 01110W Use <br /> PERMIT si <br /> r o ' M Siertaturc fiats rPersad 4757 Paas t~Gabon <br />