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<br /> ELECTRICAL PERMIT APPLId=FION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> _ 3200 CEDAR STREET,EVERETT,WA 98201
<br /> 'Asdlihrigi—ji (P)425-257-8810 I FAX 425-25 7 8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/Permits
<br /> iSSMEMENEMINIMPEREPOOMICAIMINA0WASIONSISIMMASIMMOOMOU
<br /> PROJECT ADDRESS: 4 06 c,47,-1,::( R' BUILDING AREA: sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION ADDITION 0 TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 0 SFR 0
<br /> TOWNHOUSE
<br /> '� yyi DUPLEX 0 A■DU ■ MULTI-FAMILY #OF UNITS 0 COMMERCIAL
<br /> y st.+t� S a-r: 1 �`3'a�:gg.g �V 4��13I,"`,Pr�L�,EIk oR °'i��.NEORMO _... ,. D ...: a.. - .n..HAVM KISMOn z
<br /> ``s ""`(- -i 'ASSOCIATED BUI ING PERMIT#(if applicable):
<br /> CONTRACT PRICE OF WORK:$ �1 ,3'6-:'n
<br /> DESCRIBE SCOPE OF WORK: a�"� ieri" ' Ca ve71"2-- ‹t'I4 /i,I 5c-10 t'
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO EYES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO 0 YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED):
<br /> 0 Data 0 Intercom 0 Thermostat 0 Audio .0 Secure Access 0 Security System
<br /> 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> 0 Other(List All):
<br /> maii :r-iy ,. x i "" ' - Myr w O u` �� x.`�,..t* a 'fit '+ .,.�`',..
<br /> Vic. n tis'�° '`tes4.� �� ,.y..�,����,�'� .mi� �i�i�EPJ�ll�i �e"L.c�` ����'L;B�` ? �.��,��.�,f ,.,..�..'�'�-� =..�._ :.i.._�.,.
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LS NO U 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
<br /> without the proper electrical licensing and certification,or exemption. By checking this box,I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement
<br /> a a a <s e rC' s �`_-. '}g)'a war A ]� ,�08.** 1lt a�. k I``'.'�^ '„ �`�. .. I. L 'w'6�1 5�„r,�.'..� ,.�} . .>,..
<br /> 3 3+� '�a`�i`�-L��d�4���e as�'� .�y.`.��`":',1 t�x;.t��`'`',..,`�. `��'�.r`�.�s", �- .:>r.. .his.
<br /> OWNER NAME:;Zni,/ it try 37 L.L.C., TEN NT BUSINESS NAME(If C mmercial):
<br /> OWNER MAILING ADDRESS: STREET 1 / 9i ve $ j`de", C�j
<br /> STATE�/� I
<br /> ZIP /q ..3
<br /> CITY ..�y�/".--71(
<br /> OWNER PHONE: 4/2 5 3/. 65,6-5 JOWNER EMAIL:
<br /> CONTRACTOR NAME: AJ /e' 5 Z, j.:-./-,- :.! ' J� �- ;74---1'
<br /> CONTRACTOR ADDRESS: STREET /�U%/ •5 /cJ /4.-,-- 5'C% 5'' c' ��`
<br /> env,i?-vcdr
<br /> STATE A/274 ZIP (g 5
<br /> CONTRACTOR PHONE: 7 J 3.53 7 6 4'7 CONTRACTOR EMAIL: Ao4.,i/.944 0
<br /> CONTRACTOR LIC.#(REQUIRED): ( ', f 7 y4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ye=T 5--
<br /> PRIMARY CONTACT: 0 OWNER ©CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: �4- CONTACT PHONE: 7Gj6' '7' J3 4/d`6
<br /> �� CONTACT EMAIL:dffLGr ,4TfVe:Vl,S ` .,L42 EA :7/
<br /> AGREEMENT:!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
<br /> 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
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the C work of Efor whictt Oh pic licaatli n s Only ye is and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT#:
<br /> .. / .
<br /> ;2/2„, i , E «02.- ©g3
<br /> Owner/AIfr ignat ;eC
<br /> Rate (Revised 1/11/2019) Page 1-Application
<br />
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