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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govipermits <br /> PROJECT SITS'INFORMATION <br /> PROJECT ADDRESS: q50 j I ve,, 5& �{ <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT e REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: ta,,COMMERCIAL <br /> BUILDING AREA: sq ft <br /> • - - •Tll� , � -.. <br /> llAfffy\ 5i 5 # <br /> CONTRACTL t . AS <br /> PRICE OF WORK:$ f � ASSOCIATED BUILDING PERMIT#(if applicable): eA'l� <br /> IS THIS LOW VOLTAGE WORK? 12:dO ❑YES-#OF DEVICES: , <br /> IS THIS A FIRE ALARM PERMIT? 'GINO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK: ep!4 e x;c'hods 1 diVeAdrieS iAP#A itebil c <br /> ,d k/ s t,5,, X7 4.4-,/,e • <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> ❑ By checking this box,I am stating that I have read and understand ail of WAC 296-46B-900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ATTENTION 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 certification,or exemption.By checking this box,I am stating that I have completed and signed the <br /> see Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> _CONTACT:INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): J <br /> OWNER MAILING ADDRESS: STREET (/5 / <br /> /114!:-' 4Ve.., St j1 j} <br /> CRY l>< "-eit STATE WQ�0" ZIP IVO <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:. eive ? Tee./lei/ Se& c ) LL' <br /> CONTRACTOR ADDRESS: STREET �0 nilis. t e, cit �} {y <br /> cm' „,c tf4-!JJ STATE „� 41 o ZIP n5-9 <br /> CONTRACTOR PHONE:o2C ( T"5 /t ;CONTRACTOR EMAIL: ies 3 j A ,�.;1, , afr," <br /> CONTRACTOR LIC.#REQUIRED} . � 5 tjTC, C[TY OF EVERTT BUSINESS LtC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 1 CCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,p2,01?-6.11.. 5511 <br /> 4. CONTACT EMAIL: (Gs_20033 C 3/,71 •) Lort <br /> AGREEMENT:1 hereby certify that f have read and examined this application and know the same to be true end correct All provisions of laws and ordinances <br /> 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 <br /> provisions of any other state or local law regulating construction or the performance of construction. That 1 em authorized by the owner of this property to perform the <br /> work for which application is made and f comply with the State Contractors Law 18.27 RCW and 296200 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> owner/Authorized Agent Signature Dat/ (Revised 10/30/2018) Page 1 of 3 <br />