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ELECTRICAL PERK IT &.FIRE ALARM PERMIT APPLICATION
<br /> CITY OF EVERE I"T`PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVER TT,WA 98201
<br /> (F')425-257-8840 l FAX<425457-8857 1(E)eeerettepseeveretlWa.gov J vome,everettwe.govipermke
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<br /> PROJECT ADDRESS lip.. e .,'' � .
<br /> PROJECT TYPE: Q NEW-CONSTRUCTION CI ADDITION Ca TENANT IMPROVMENTT %REMODEL
<br /> BUILDING USE: I SFR. ©TgNVNHOUSE CI DUPLEX CI ADO CI MULTI-FAMILY-#OF UNITS: _ *: GQMMEHOIAL
<br /> BUILDING AREA:,__________Aq srI R
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<br /> CONTRACT PRICE OF WORK:$ SSOCIATEDBUILDING PERMIT If Of applicable):
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<br /> IS THIS LOW VOLTAGE WORK? PNO 1 YES'-#OF DEVICES: ., . . ,
<br /> IS THIS A FIRE ALARM PERMIT? litNO CITES-Plans required for teem(Both Electrical and Fite Department inspections ere hired)
<br /> i.--.,,,"•-:,‘ h^'n u $ G -1 �. 7, a a 5 . ' -t t4.1‘;',,:r
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<br /> DESCRIPTION OP WORK: q!4 4 eco S*N .. a 0 is 'to;� . i. « > ,
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<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIt NAL,HEALTH ANDIOR PERSONAL CARE FACILITIES:
<br /> 0 By checking this box,I am stating that I have read and understandall of WAC 2e+a -9OO, acted the specific men on page
<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 ':P ,re Plan Review.
<br /> ATTENTIO$OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICE NSLIRE
<br /> 1Pursuant to ROW 10•28-261,property owners end erneenolders oannre perform aleclr]uelwork err lwi dings for rent,sele,or lease without
<br /> . the proper electrical licensing acrd ontilication,or eXSITIptiOTI,,Ey+checking this box,I ern stating that I have completedand signed the
<br /> goo 3 AFFIDAVIT on page S of tirls applIcation•to receive an exemption from this licensing/certification requirement
<br /> OWNER NAME: TENANT BUS -SS NAM Commercial: ,,s;-.
<br /> OWNER MAILING ADDRESS: STREET s h1V I Y. .r
<br /> OnY G STATE ZIP B i 02,438*
<br /> 'OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME:.. 4' , .
<br /> CONTRACT*R ADDRESS:: . sTTr r ,. 0 r b A..
<br /> i A'f STA ., o. zfp # 0 4CONTRACTOR.PHOI,E€r ev' '°°.6; ' CONTRACTOR EMAIL: ''s • , ,,,,
<br /> CONTRACTORLie.'.<REWIRED:, ” .irbritaCITY OF EVER EU, ESS LIC.ft REQUIRED:
<br /> PRIMARY CONTACT: CI OWNER : CON114ACTOR Cl OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT P}}tONE: , '- , -- i
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<br /> r CONTACT MAIL: * .2 Ai 3 '' ,2 . ; -
<br /> AOREEM1:NT:I hereby cad*that I haver d.and exemmed this application end know the Sennett)he .-.andcOrhtfoL All Pmvisiruzsend ordinances
<br /> ,governing this type oft rtc wltl he completed whether speclNod°he etn or not. The grsraftrrp of a permit does hot plasma to give srlItnrily i0 violate ar•cancai the
<br /> provisions of any other�state orMeal low regvleengg catiatmothar orthe perfrmsnce of constmclim That I am authorized by the n serotthislavertyto perform the
<br /> fk fcr which application's made and l comply with the State Co/elect=Law 18,27!RCWand?382QO WAC;
<br /> City's everelUlftidel.t use ofty
<br /> Of PERMIT*, . .�s ..
<br /> wrier/Aut prized Agent Signature Da (Revised 10/3a'20.1e) Pogo i o i 3 W--•-
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