Laserfiche WebLink
ELECTRICALERMIT & FIRE ALARM PIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES. <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)428-257-8810 1 FAX 4254257-8857 1(E)everettepsigeverettwagoV 1 www.everettwa gov/permits <br /> M 4 i pit'g... 0 *i O CT.SITE INFORMATION ;, :-.;;;;,-Mr '. <br /> PROJECTADDRESS:8102 OWVi D r �v v:4�-, jSf A tici { <br /> r� , <br /> �1 <br /> PROJECT TYPE:nNEW CONSTRUCTION E ADDITION ❑ ENANT;IMPROVMENT Lai REMODEL <br /> — <br /> BUILDING USE: f FR 0 TOWNHOUSE 0 ®UPLEX ❑ Li 0. ULTI-FAMILY-#OF UNITS: ❑ OMMERCIAL <br /> BUILDING.AREA: 2100 —N. <br /> q ft <br /> .._ . .ELECTRICL. !"PLICATION INFORMATIO �w. <br /> CONTRACT PRICE OF WORK:$ 16 OO IASSOc.IATED BUILDING PERMIT'#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 'Q 0 © ES-#OF DEVICES: <br /> IS THIS A;FIRE;ALARM PERMIT? pJ 0 d YES-Plans required for:review(Both Electrical and Fire Department Inspections are required) <br /> SA .1 ' . <br /> DESCRIPTION OP WORK CODE,:.COA 0ANCE °` <br /> DESCRIPTION OF WORK: C� amp rt'ge <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> iniBy checking this box,I am stating that I have read and understand all Of WAC 296.46 00,selected the specific reason on.page.2 <br /> of this application(see next page),AND Plan Review/SNOT OT 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 /> rim Pursuant to RCW 19.23.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without <br /> Llimil the proper electrical licensing and certification,or exemption.By checking this box,lam stating that I have completed and signed the <br /> See Pagers AFFIDAVIT on page:3 of this application to receive an exemption from this licensing/certification requirement. <br /> '. .. .. : w... . ,:,';',C..CIINTACT INFORMATIONr 4;;-4,;',4,-.-",'',':::','A <br /> OWNER NAME: TIM 4101 TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING:ADDRESS: sisal' C 02, OrMAIVA DI(' <br /> OWNER PHONE OWNER EMAIyLL > <br /> CONTRACTOR NAME: In AttuSe, to G ee/Wj/ <br /> CONTRACTOR ADDRESS: satEeT 1131) �t ri t ift• t)r' SE <br /> `,� /} <br /> Cnv tioulfe .t '.' Y S STATE y 4(/ 0-2_ g, <br /> CONTRACTOR PHONE:i2.-. 7( O 32.©3 JCONTRACTOI't EMAIL: i'' I ' `�` It G€'j> ', <br /> CONTRACTOR LIC.#(REQUIRED): ft f J 9 20 7 _CITY OF EVERETT BUSINESSLIC #(RREQU1RED): jte�; <br /> PRIMARY CONTACT: 13 aWNER jr•NTRACTOR THER.(PleaseSpecify);. <br /> CONTACT NAME; CONTACT PHONE: 42. Q 7,977.Ke/tf4j L <br /> rCfl-CONTACT EMAIL: f i . „ 1., <br /> AGREEMENT:t hereby certify thaft have read and examined this application and know rile same to be true.and <br /> correct t prrlvt§twrs of taws and ordinances <br /> governing this type of wort(will be completed whether specfied herein o snot. The granting of a permit does not presume to give authority to violate or cancel the <br /> provisions of any other state or local taw regulating consinrction or the performance:of construction, That!am authorized by die owner of this properly to perform the <br /> work for which application is made and!comply with the State Contractors Law 18.27 RCW and 298.200 WAG <br /> City of Everett Official Use OnIY <br /> PERMIT <br /> 114111, /2110. - ks& 7 —e4'— <br /> Owned ,q,. <br /> . gent'Signature sate (Revised 10/3012018) Page 1 of 3 <br /> Scanned with CamScanner <br />