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ELECTRICAL PRMIT & 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.gov/permits
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<br /> PROJECT ADDRESS: 1 to 2, S. a6 .0(( IMAzA-WAS°(
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 1.REMODEL / g-C-jte0 j
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: }.COMMERCIAL
<br /> BUILDING AREA: sq ft
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<br /> CONTRACT PRICE OF WORK:$ /qcz ASSOCIATED BUILDING PERMIT#(if applicable): N/4-
<br /> IS THIS LOW VOLTAGE WORK? �,NO 0 YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? VNO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: (22oftT l-e rrigioN2 MA— Q _ L t-TA c DA ' ki T-64.
<br /> g%. -O . Orr E:iI TT MA-LA—
<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> 0 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 /> 0 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: RQ..p -r€ [,)..(LE'') L.LC TENANT BUSINESS NAME(If Commercial): "'Me E I .eri- WW1_
<br /> OWNER MAILING ADDRESS: STREET %'*O - se. E,ra.2cTr is.,_ wA '� /j •,
<br /> cm, t-:
<br /> Cv ` STATE WA- ZIP /E Li '8
<br /> OWNER PHONE: ([ 31 -079 OWNER EMAIL R'i . WOOLS E AM-71.L ,I G�
<br /> CONTRACTOR NAME: ?(2-4:>t_(G(11 1...... .-.-.7t, , LI_G
<br /> CONTRACTOR ADDRESS: STREET Zy-O P JEL o/J EL-Jt
<br /> CITY 0 f e.C.E-1-[ STATE IA/A(14ZIP 982_0/
<br /> CONTRACTOR PHONE:4-2_s-,7�1/ OC (CONTRACTOR EMAIL: rl C.. 17troIlgit'E-t . Could
<br /> CONTRACTOR LIC #(REQUIRED):PPO L 1��E NF1?' JCITY OF EVERETT BUSINESS IILIC:#(REQUIRED):to03°L3.,±1:741
<br /> PRIMARY CONTACT: ❑OWNER XDONTRACTOR 0 OTHER(Please Specify) S S 'bC,
<br /> CONTACT NAME: CONTACT PHONE: 14-1„,s- _i ' s"--(o o
<br /> K` C-k4- 4,..L,eN CONTACT EMAIL: .6 P(o,rd`n _N`e.cc. Ltsy„l
<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 sta- - • - - -gulating construction or the performance of construction. That I am authorized by the owner of this property to perform the
<br /> work for which ap =ion is made and I col ply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> Otr,
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> Owner/Authorize. A.- '.naal i e Date (Revised 10/30/2018)
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