4818 RUCKER AVE 2026-05-01 - Laserfiche WebLink

ELECT° L PF-IIT & FIRE L " IT° APPLICATION CITY OF EVERETT PERMIT SERVik ES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-881 o i FAX 425-257-8857 9 (E) everetteps@everettwa.gov � www.everettwa.gov/permits ELETRiCAL 14PPLICATI0 MATIifN CONTRACT PRICE OF WORK: $ ASSOCIATED BUILDING PERMIT # (if applicable): IS THIS LOW VOLTAGE WORK? ZINO ® YES - # OF DEVICES: IS THIS AFIRE ALARM PERMIT? NO ❑ YES -Plans required for review (Both Electrical and Fire Department inspections are required) DESG1 iP'I"IQN 6F, WORK & GODE.;;COMPLIANCE DESCRIPTION OF WORK: "f4&()EA40 IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ONO ❑ YES — See Below & Pg. 2 ElBy checking this box, I am stating that I have read and understand all of WAC 296-46113-900, 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 Par: Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: MNO OYES -See Below & Pg. 3 Pursuant to RCVV 19.28.261, property owners and leaseholders cannot perform electrical work on buildings 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: �� J(�+ �- TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: srREET , jeJC*- CI-Y STATE ZIP OWNER PHONE: Ct�� ' QJQ� OWNER EMAIL: .. CONTRACTOR NAME: L o C CONTRACTOR ADDRESS: STREET 2� ! iP L ,S L Q �_JL CITY +il I STATE `r ZEP � �U CONTRACTOR PHONE: ZS'970-600 CONTRACTOR EMAIL: k~7Y�� 'Lk/_4—)P_ O- � %�,.A-j ' CONTRACTOR LIC. #(REQUIRED): a3 k -3 cii-q S'& D CITY OF EVERETT BUSINESS LIC. #(REQUIRED): (41r�'?5 3- PRIMARY CONTACT: 5 OWNER 0 CONTRACTOR © OTHER (Please Specify) CONTACT NAME: 0 t V) r* V©& &L CONTACT PHONE: Lj��. CONTACT EMAIL: AGREEMENT: I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type 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 local law regulating construction or the performance of construction. That/ am authorized by the owner of this property to perform the won't for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Owner/A tho ized Agent Signature Dafe City of Everett Official Use Only PERMIT # (Revised 111512016) Page 7-Application