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ELECTRICAL P •VIIT & FIRE ALARM PWIIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVI S
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
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<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits rvE77
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<br /> PROJECT ADDRESS: S/ 1 Y` G'� 6'-r V-I�3'
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION' 0 TENANT IMPROVMENT 0 REMODEL ft--ippv/g,
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> BUILDING AREA: 4sq ft
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<br /> CONTRACT PRICE OF WORK:$ 0 Ca CP.--2 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? t•NO 0 YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: Ro.1v•cniko q, fano (a is ��4,,;. Lac. p
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Lj O 0 YES--See Below&Pg.2
<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 Pag 2 require Plan Review.
<br /> ARE YO AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO''ES-See Below&Pg.3
<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 age 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> �orNr�cr �
<br /> OWNER NAME: 2.. (A„..446, Sb CAA TENANT BUSINESS NAME(If Commercial): s 0.4-J” t€A2 C-.—
<br /> OWNER MAILING ADDRESS: STREET 3�Z Lv o_') &)L.)
<br /> CITY S_a_ 41, ! ;� STATE L,. p zip L C
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<br /> OWNER PHONE: it OWNER EMAIL: .✓1 A r2iL L • 3 n •Cew.►
<br /> CONTRACTOR NAME: <DK, ('—
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHO : !. 6:2 (a ►.A - ; r.n
<br /> CONTRACTOR LI .#C (REQUIRED): ICIT OF EVERETT BUSINESS L C.#(REQUI D):
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2��,. z - ""Z
<br /> X122.Lit.f ✓tea CONTACT EMAILL2,.2 L" • G
<br /> AGREEMENT:I hereby certify that t 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 WAG
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> .1„ 491_0_
<br /> Own- • horized ure Date (Revised 11/5/2018) Page 1-Application
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