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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> "111.P./04. -71 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3/s E - C`4S/A/ <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION WENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: arCOMMERCIAL <br /> BUILDING AREA: 300C) gcnctOKI ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ I/500 ` Id ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? WO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? 10 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION/OF WORK:y� �� .t1d? j ' 4C C/ettett,.�+ # !OW 4.66 /Zoo <br /> cit <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> ice\; ch n• zd and understand all of WAC 296-46B-900,selected the specific reason on page 2 <br /> �.�. ��31�.,•���••- . �•.•.=- DPI.. 'eview is NOT required because I meet all of the following sub sections that do not <br /> -'�a%e 2 e Plan Review. <br /> ATTENTIO. OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> Pur . _• to RC 19.28.261 y.• y pw — leaseholders cannot perform electrical work on buildings for rent,sale,or lease without <br /> .:•�,' 'l• •�i ''r . •"��a . �i z. u�•� -xe••• ion.By checking this box,I am stating that I have completed and signed the <br /> See - 3 AFFI' • I • .•• = his application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> i <br /> OWNER NAME: 7 yeti gr TENANT� BUSINESS� NAME(If Commercial): 3 yJrnlWS <br /> OWNER MAILING ADDRESS: STREET �7//� wrg�YY ieu�eSo K /y <br /> /, CITY EPOleo : �J. STATEPA' ZIP r V3 <br /> OWNER PHONE: -0,4 OWNER EMAIL: N/"' <br /> CONTRACTOR NAME:: rFig�ir"- 84LL ,`,470C, <br /> CONTRACTOR ADDRESS: STREET /926 L k.65 Ade- <br /> .as!CITY N ♦ STATE ZIP 7g434, <br /> CONTRACTOR PHONE:r6"Z'$ -leas CONTRACTOR/ EMAIL: W IEt'4�G ji,,y et C� <br /> CONTRACTOR LIC.#(REQUIRED) AtsTrnri�G CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 09/ <br /> 403 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) A' /� <br /> CONTACT NAM �Dg <br /> CONTACT PHONE: LS —760 <br /> scot- F N5 CONTACT EMAIL: oIeSj41. jSd1:9N . G'a <br /> 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 <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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> f ACity of Everett Official Use Only <br /> PERMIT# <br /> 117,5,/1 <br /> Own orized Agent Signa re Date (Revised 10/30/2018) Page 1 of 3 <br />