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<br /> ELECTRICAL, PERMIT APPLICATION
<br /> ON
<br /> c.. OF E 1Ei2i"TT PE13MtT SERVICES•
<br /> E VE R E.'+ i 3200 CIC)"AI'k STREET.EVERETT,WA 9820I
<br /> w4aarsr4-oro t (P)426•26X-8810 SAX-428=257 886T (0)everetteps(everettwa.gov 1 rwvw everettiwa govrpen i ,
<br /> PROJECT S1r41NFOI ATIOP
<br /> PROdi CT ADDRE.8 * 3:003 +'EST CASINO ROAD 4 ', BLD Ot BUIL I GAREA;,�ltwlf sq
<br /> ROJeCT TYPE: Q NEw: 41A.00TION [ ADTION 4 TENANT IO Rai. ri r REMO 3EL
<br /> BUILDING USEi 0 SFR t1 TOWNH©UsE _DUPLEX. " 0:AOV .;C.MULTI'FAMILY #t UNITS;
<br /> GarmERclaL
<br /> . IEtI T CA1.APPUCA:TION I ORM,A,'TIO :.&. DESCRIPTION OF WORK '
<br /> CONTRACT PRICE OF"W`OIRK:$.....S0oo IA2.SSOCIIATED SUILD1NG PERMIT#(If applicable):
<br /> DESCRIBE$COPE OT WO K
<br /> REPLACE FIRE ALARM HORNISTRoaES.1N HANGAR AND PAINT MIXING ROOM
<br /> .
<br /> ;HIS INSTALLATION INCLUDES THE FOLLOWING SCOPE,(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? NO El YEs,_Select Scope:0 service C ,Feeder El Circuits-#. 0 Cori plete`Re-wire
<br /> LOW VOLTAGE WORK? 10.NO YES-a`of Devices:2s
<br /> SELECT$COPE(RErauIRED): 0 Data El Intercom• •CI Ttiemioslat 0 Audio D,Secure Access D.security system
<br /> ca Fire Alarm ,Installations:under this permit only include electrical wiring rough4n of the system.An additional
<br /> Fire.Alarm Permit•is requiired for review of device Ia tivri•alit fostailalon approval.
<br /> 0 Other(ListMY, .
<br /> - ' ..: OODE COMPLIANCE f :''
<br /> IS THIS PETIT EDUCATION,ll OtrI UTIONAi.,HEALTH AND/tit PERSONAL'CARE FAOILITIEsi
<br /> [,,_::} By checkh this,;box,I.am statingMat I have read and undelstand all°of:WAC 2t 4e8»9p,Qx selected the:speciftc reason on page>2.of thi 'appllcafion(see next page),AND_Plan Review is,NOT required because I.meet aft of the following sub socilone ttit t do not See Page 2 requlrePlan•Review,
<br /> ARE'.YOU AN OWNER PERFORMING WORK A8"r•I•hE CONTRACTOR WITHOUT ELE•CTRICAL •LI ca.
<br /> SUR•E:
<br /> [Jnto CIYs-sue Below Pg:s I?tuenant to R i8,28 289,property mMe'rs aril leaseholdsm cannot se* electncet work on buildings for•rani;sate,.or lease<
<br /> without the•proper electrlcatticensing and c ertiflcafloe,or exatnptlan.Ely chec cing this box,I am stating that•t`have completed arid`
<br /> see Page 3- signed the AFFIDAVIT on page 3 of this application toreceive.en exemption from t is`licnsingicertlficalion ragtttreitment
<br /> • CONTACT INFORMATION"
<br /> OWNER NAM'Et BOEtN ; TENANT SIIBINE88.I!t is upommerclo 48=Q'1 '
<br /> •
<br /> Owl 1tiR lYlAli�tNG AID � BE�f��(�� O
<br /> ORESS eraser 30C1$WEST CASINO ROA©'40-58 Bldg*Col::BS-2
<br /> ...coy, -EVER TT
<br /> OWNER"PHONE• P NERE '(Alka
<br /> CONTRACTOR NAME: ALEXANDER�'t OW,FIRE EQUIPMENT Ct7.
<br /> W
<br /> CONTRACTOR ADDRESS: eittEsr 1438 NW 53RD.STR T .
<br /> anm±.•SEATTLE • • 'mit WA
<br /> iCONTRAG'ro A EMAIL:ktTtuQenQgow#irra.cgm
<br /> CONTRACTOR i lC.#REOulR :At,EXAGFO9TNt+tt •1CITY OF a ETT BUSINESS LIC,#(FtEQtIlI:2EQ)t.Q6t3Q29.
<br /> PRIMARY CONTACTS• DOWNER .(ZICONTRAtC I`OFt 00'l'ffiEFR(Please Spectfi0;) • -
<br /> CONTACT NAME;. CONTACT PHONE`206 718-f1QoE"
<br /> EVIL ULLE .
<br /> 991.1 `4PTAMAIL.kmull.0009 t9tlte orrt
<br /> " t# A°MEN I i e, T Yat�' 'tat(hhve rea i .'..' �rgdt s a,m and xnaw�he..aerrta fa�tae ttre a�ala .' i1t!
<br /> 1!�Ae o/ wig be OG Meteut+rhetheeerreoN ltaraTn oroal.the grerrllrrgofa p,rn rkses not l swine to hra. O q•ot/awa 4provsions •
<br /> eVe yoThers •
<br /> koar tp tr tt to vtdtat oi'oan•for the prre+tsh et ifi enyortreandl ter;
<br /> raga/a g crrra r, twin c.the t, ...,., ....,rbe,• crrir•rsretrpi%, Prat•Famalitharizecr/ry lha owns:satrh s;a er r, the work"krr ivP�kYa at,. , rr S m da,„,. •
<br /> aomptywlllr 04.Slat eiinfraatorstaw.'5827 ROW and 296:200 WA°. •
<br /> Oltsr of EV*Mt.O ftcial!#ee only
<br /> PER tI7"#:
<br /> erIAuthorlxed Agent Signature. fate-
<br /> (Reviserl lIJf/2Qf9). gaga 1 lepWicatlon, •
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