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ELECTRICAL PERMIT& FIRE ALARM P IT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> 401
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 2 4 e P11O y R t�
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT ®REMODEL
<br /> BUILDING USE: 10 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> BUILDING AREA: sq ft
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<br /> CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? KI NO 0 YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: r- X14 C,c cr-+� 4Pf3 e-A. 9th`1.1@nq4)
<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> ❑
<br /> 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
<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',INFOR1V ATI©N
<br /> OWNER NAME: Gt PP a .i\ TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET J ; 1 I C Yr 'Y
<br /> CITY E VLA z ? �'"� STATE ZIP '7�$263
<br /> OWNER PHONE:e o � 3'a Co OWNER EMAIL: ` ii��
<br /> CONTRACTOR NAME:It �VI �u,n._ tq,r,
<br /> CONTRACTOR ADDRESS: STREET11 A L, 2#it-G._ PA.,
<br /> CITY V STATE /.L ZIP 6bbb6 62 ^3
<br /> CONTRACTOR PHONE: '12S4-350—,51/4.1 'CONTRACTOR EMAIL: -ct.)11S ,v} `�ry�`.dt2�gGq� 'L. -yyt ,Cpye,„_
<br /> CONTRACTOR LIC.#(REQUIRED). _' rut.v5trot' '0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Los---330-;x-(69
<br /> TO3A ) 11% ./\(:)-11:1-4 ---- CONTACT EMAIL: �.jI(
<br /> AGREEMENT:I hereby certifylhat I have read and examined this application and know the same to be true and 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 I am authorized by the owner of this property to perform the
<br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> IL119118 0( i1-f7I
<br /> Owner/Authorized Ag nt Si ature Date (Revised 10/30/2018) Page 1 of 3
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