5415 EVERGREEN WAY COASTAL COMMUNITY BANK 2019-02-05

ELECTRICAL PERI & FIRE ALARM PERMIT PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits 07477.' PROJECT.SITE INFORMATION PROJECT ADDRESS: 5 t// Cjffi`'�r€eM i3 / F bull f er,za PROJECT TYPE: EINEW CONSTRUCTION ❑ADDITION EMI TENANT IMPROVMENT IIIREMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE nDUPLEX 1ADU 0 MULTI-FAMILY-#OF UNITS: 1, COMMERCIAL BUILDING AREA: o26.66 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ D34/, ASSOCIAT- U D PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO IS YES-#OF DEVICE.: 02, IS THIS A FIRE ALARM PERMIT? ®NO 0 YES-Plans required for re -, :oth Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: ,7-Pi„[J aellii c ,,i6 4 1,.7 /WC) p s THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: fBy 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 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: (�'� Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without u I the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION / OWNER NAME: TENANT BUSINESS NAME(If Commercial): / j/326/L D/I1/n/J/2, y41444 OWNER MAILING ADDRESS: STREET ��J11 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: (1.$C O — O 3(4. CONTRACTOR NAME: Nig,/,e-it e.A 6/7MO40thi/1J C CONTRACTOR ADDRESS: STREET O,czd wld, fid" `! (-/a)z,lex p 52r)CITY 79/11144 AI& STATE i�24 / ZIP Olaf 75- CONTRACTOR PHONE:("pd7g7-"Led 1 CONTRACTOR EMAIL: /1 ewi.e.I 1 L neW/tocd CO/n/21 , e /Y/ CONTRACTOR LIC.#(REQUIRED):A(6- 'JEG,z /$(p 370 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): f23(?'. ' 2 PRIMARY CONTACT: COWNER JONTRACTOR nOTHER(Please Specify) CONTACTC/�� NAME�/: CONTACT PHONE: /vots'�J,57 -/179 806 >Ka.FI�S CONTACT EMAIL: ,obAla_/itS °c,/lewfecl GUA7/12. C, - 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 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 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 work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. aiN_________________-- City of Everett Official Use Only PERMIT# L. VA ..— 04(JO Owner/Authorized Agent Signature Date (Revised 10/30/2018)