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ELECTRICAL EMIT & FIRE ALARM P EMIT APPLICATION
<br /> 14 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
<br /> 4.77.
<br /> v ,v z � PRO ECTS1EN9RMATIc $
<br /> .
<br /> PROJECT ADDRESS:1..07 to
<br /> e veegreee t'►--ky t°(.ire-f1 tit, C( (J 4�-Ot
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> BUILDING AREA: sq ft
<br /> a "ws: ,.e tr�.. ..< . .._.- 4 .u:i "xtttt.E ' iltrd L Aiifit dAtt1a lid, i�: a �x •� ° i �_< \
<br /> W....r.,..':zsem r�m'�;v -�%,,,gE ._ r... . >kc a: .r.,t' .:'4,' a
<br /> CONTRACT PRICE OF WORK:$ -%-/ 7®a® ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? 0 NO 12 YES-#OF DEVICES:.
<br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
<br /> lsir, ' k att..a s ' P l � �F a!■ i�41 � 4O*A i t,e �r�` a� e a �.�
<br /> .<:s�.� ,��a_a .,. ,-- ,. ,s .� .... 5...,..s N r'�����.; �,.,.,.,....a y,a....x.:a�.7.. �;.e.<...,.S.E.i, o:.:_�, .m��'xs,��.t�a�.,... .1., ,,.. ._...,....�?., .,'1.w. _.. ..� P„., .,,.,.. .v,.,. ,...,.
<br /> DESCRIPTION OF WORK: Add , p,, j t- "Ac/c4 e- L--o - kc rS 0„-1-9 Tie_ F ('p' ate 1,--e-,4
<br /> i.-i 1 k /11e W t-- At- vo/ 6194 a A CI i---D 1,.,- vo i es t
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO 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 Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO OYES-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 Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> C OlNTACT IN63.1ttl1ATION
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): e p it- a 5, iei /11-kItct yGil..J-
<br /> OWNER MAILING ADDRESS: STREET f/�a ij Px / 72-6
<br /> I -1'1724
<br /> CITY 5641-He- STATE ZIP qg t I`
<br /> OWNER PHONE: )-96 5-051 OWE OWNER EMAIL: /(15/1711 erce/viGe ,q1 C.-4,S G .Cr?M
<br /> CONTRACTOR NAME: (4 h IX (Q CI Y e-
<br /> CONTRACTOR ADDRESS: .4)3/®6STREETT L/y t� Art-
<br /> h(i
<br /> CITY 5hive%`n STATE,QA. ZIP 4'44 J[—5—
<br /> CONTRACTOR PHONE:X06 6-75"v?3 7 CONTRACTOR EMAIL: 1.®tit:h'il ey._6 A,C ko115 Gt Lill);71/ ekeilli c....69"
<br /> CONTRACTOR LIC.#(REQUIRED):(ASR o y a-6i lei�R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): t-($ 3-5-4PRIMARY CONTACT: 0 OWNER Cl/CONTRACTOR 0 OTHER(Please Specify) .
<br /> CONTACT NAME: CONTACT PHONE: L06a ' ?r 6 J 37, •
<br /> bizAcion wk 1.1-1-e- CONTACT EMAIL: lcz i4' W, 0 tn.n r 1" 'eSe c-iric- O'
<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 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 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> (6(Agi t4/4; oviet 'Elsc0( — '0 5
<br /> Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application
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