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11/07/2018 22:16 2535723628 ROBBLEE'S TOTAL SEC. PAGE 01/03 <br />ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�W(P) 425-257=8810 j FAX 425-257-8857 1 (E) everettepseeverettwa.gov I www.everattwa.gov/permits <br />. • iQ. 11IT''SI'Y'If -INFORMAT, low <br />PROJECT ADDRESS:. ®L4Z111t'i U ;;'lf l iX1 vc- g <br />PROJECT TYPE: MIS <br />BUILDING USE: I E31 <br />AREA: 1500 sq ft <br />n <br />PRICE OF WORK:-j 15000 <br />THIS LOW VOLTAGE WORK? <br />THIS A FIRE ALARM PERMIT? <br />ON I❑ frENANT IMPROVMENT <br />-#OF <br />Y-#OFUN <br />INFORMATION <br />PERMIT # (If applicable): <br />requirkd for review (Rq�14 Electrical and Fire Department <br />O11:5CKIPTION-'pfWOII KA C00,0'OOMPLIANC12 <br />DESCRIPTION OF WORK: GATE OPERTORS FOR NEW HOUSING DEVELPMENT <br />are <br />MMERCIAL <br />HIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: <br />By checking this box, I am stating that 1 have read and understand all of WAG 296-4616.900, selected the specific reason on page 2 <br />ILL�J�I of this application (see next page), AND Plan Review is NOT required because I meet all of the following subsections that do not <br />Sae Page 2 require Plan Review. <br />.TTENTION OWNERS: THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br />Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without <br />the proper electrical licensing and eartlflcatlon, or exemption. By checking this box, I am stating that I have completed and signed the <br />Sae Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certifioation requirement. <br />CONTACT -INFORMATION <br />OWNER NAME: POLYGON HOMES TENANT BUSINESS NAME If Commercial): JR HAYES <br />OWNER MAILING ADDRESS: sTRFE'r <br />Carr STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: ROBBLEES TOTAL SECURITY INC <br />CONTRACTOR ADDRESS: STREET 751 TACOMA AVE SOUTH <br />CIrY i'ACOMA STATE WA 7.IP 98402 <br />CONTRACTOR PHONE: 2536275448 <br />CONTRACTOR EMAIL: JIMTP ROBBLEES.COM <br />CONTRACTOR LIC. # REQUIRED : ROBBLTS994JD <br />ICITY OF EVERETT BUSINESS I,IC. REQUIRED)', 054194 <br />PRIMARY CONTACT: <br />❑ <br />WNER <br />ONTRACTOR <br />❑ <br />OTHER (Please Specify) <br />CONTACT NAME: <br />JIM PATTERSON <br />CONTACT PHONE: 2536275448 <br />CONTACT EMAIL: JIMTP ROBBLEES.COM <br />AGREEMB'NT.. I hereby certify that 1 have read and examined thls application and know the Rame to be true and correct. All provisions of laws and ordinaneea <br />governing this type of work will be completed whether Rpecified heroin or not. The granting of a parmlt does not presume to give authorlty to vlolate or cancel the <br />provlslons of any other state or local law regulating construction or the performance of construction. That / am authorlmd by the owner of this property to perform the <br />work for which applic9tlon /s made and I comply with 1h0 $tare Contractors Law 18.27 RCW and 296.200 WAC. <br />0WKr/A(uth­o0&atjX9ent Signature Data <br />City of Everett Official V9e Only <br />PERMIT # <br />(Revised 1013012018) 4 ..ems.— <br />