35 SE EVERETT MALL WAY 2025 DIZAYUS AFRICAN MARKET 2025-11-03

EISECTRICAL PERMIT APPLI.TION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECTHail SITE INFORMATION PROJECT ADDRESS: '35 r (- vei f rtl a i l tv l BUILDING AREA: i 500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL 0 S( )Y) BUILDING USE: L SFR El TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ,COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ LI '" i , Cc ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: LA k A 1 -c l ec 1 -(cc-1 51 cr c _,I_.- I I 0 m(r'i Ca-<1 Lc i° ail c1 c, I ail nr'1 ie H-i is I. -- S-i c, lecl c`> 0- 5i nJ le__ r'etcc'1,0aY' THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO X YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. X Other(List All): <..3 ( co I ! ,3-+cc. l I e CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: Eil NO ❑ YES--See Below&Pg.2 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 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURENO _YES-See Below&Pg.3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on uildings for rent, sale,or lease without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME:Ct L `�V' -U. l7i\c` 'F)Ci'1 an TENANT BUSINESS NAME(If Commercial): A-6r i Can i 1(.t,(-K — OWNER MAILING ADDRESS: STREET ,:2j C) �j F. E._ \i'e r t('‘ H. a,1 f to a_y- \/t `s)L/i� 103 /� CITY ye v / STATE 'V r ) ZIP C 2 6)X OWNER PHONE: 2,6)47 ` 41 12"- 5 5-3"2.... OWNER EMAIL: .y j�+,c,(AIDCIj a ) j..1-\�L . ']'. rncti. I i COifl CONTRACTOR NAME: h-curl V-_. (3 c "r--1 z--c e S ( I fl`j f c _)1 Ik i CONTRACTOR ADDRESS: STREET �/�C�. / 2__, / '/)c_1 h I 1 r-' ve Y 1- Lu i CITY // 1 I I ( e I�C-��1`� L STATE ,Tl ZIP C S 1 ♦�2"' CONTRACTOR PHONE:` 2,5'1 :-�O i 9) I(00 CONTRACTOR EMAIL: 151h AT j i,) OS ( HS/'Q i Cc rn CONTRACTOR LIC.#(REQUIRED):6 F3 j 5 I SA Ct 9 0 'P C' CITY CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 055 r 0 / PRIMARY CONTACT: DOWNER ❑CONTRACTOR OTHER(Please Specify) (-3 (G) r) C 0I''l C?C 10( CONTACT NAME: CONTACT PHONE: vl ) 1 1 9' 5 1 — Lam) 3 (.4 ( hC,t,'t'C: ID.L'van etei,-,6'l1vL�i`.1 CONTACT EMAIL:17avec > sic1 ;lC,',cG,h1C\, CVC(C+, (l,Ull7 AGREEMENT:I hereby certify that I have read and examine his application and know the same to be true and correct. All provisions of laws and ordinances governing this w-vpe 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 :'ocal 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: r/ /2� E 22 2_ - c� Co Own r/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application