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ELECTRICAL PURMIT & FIRE ALARM I=RMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:1 V,y I 1 QOl kS nevelt- °f H2O PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT `REMODEL BUILDING USE: 1217SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1 b7 0 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? NO El YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Moto( o}D jun -2-mo wrArticaw I016-.-63 IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO CI YES--See Below&Pg.2 ❑ 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 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. ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: LINO EYES-See Below&Pg. 3 ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease without 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: Niol V1t2'j li0,110 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET (S V1 � '-I . s CITY �' v `_ / STATE n/A ZIP LC OWNER PHONE: QV/4 OWNER EMAIL: CONTRACTOR NAME: \V1 MA5 e �j I-e--(/t VI(/ CONTRACTOR ADDRESS: STREET I \\ I) ISTX111\ ( '^ I /�(� Q� CITY LG�k.Q, cTQAteA l S STATE VVI ZIP (`(J2�`C) CONTRACTOR PHONE: 125 7(PO 32 )3 CONTRACTOR EMAIL: 'VLe/p(A4VY1115(O VV A(• ( J47 l CONTRACTOR LIC.#(REQUIRED): 'N il-0I/VF 5 q2.6,(6-1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O 4 L1 t CO Q) PRIMARY CONTACT: ❑OWNER re CONTRACTOR ❑ OTHER(Please Specify) 7 CONTACT NAME: CONTACT PHONE: 4/5 �3� q7 CONTACT EMAIL: v\x/e, n1 l A n,,x AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Al4ovisions 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 is application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# /272-0((s \2- \2'-\ Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application