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ELECTRICAL PMIT & FIRE ALARM PLIVIIT APPLICATION <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �S t%S SE ti V O. '. t/0 GLt cs1� i)f--e r y <br /> � <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVME El REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE 0 DUPLEX 0 ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 3C)C) ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? ❑NO El YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? RNO El YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF'WORK &CODE COMPLIANCE <br /> DESCRIPTION OF WORK: • nol, 0,19,dy'i elii rpi,m* th , 'c Jsireq t' 4,,,i, ohe�-i'i ra -4r, <br /> 55i-214 -17, ¢fit i�,�-i n q A,/.n, psi h,e�,i-t- .1 <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: CI NO 0 YES--See Below&Pg.2 <br /> EfBy 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 YOUN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:01O OYES-See Below&Pg.3 <br /> 1_2( <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 /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> p <br /> CONTRACTOR NAME: 61-7JJJJn, 6Pin c , t !�T/_,L��(y/��/,� /11Xb <br /> CONTRACTOR ADDRESS: STREET pQ,�)/4•A f���` T 1 V.Q. r�7F <br /> �j,,_,yyyypppp r <br /> CITY Ii.JLllll, STATE uJt ZIP 9�Opi-i <br /> CONTRACTOR PHONE: 4,2,6j /-I i O fl-1- CONTRACTOR EMAIL: 6 Pen e(lab a UDI • corn <br /> CONTRACTOR LIC.#(REQUIRED): SPG(\1( 4N O b L ei CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 59K s co <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR VOTHER(Please Specify) Ala-6 r i 7cca -A-. ‘ a:. <br /> CONTACT NAME: CONTACT PHONE: Dora, — j,6 e _ 3 e1 e1 C.1 <br /> `T°riA3 L CONTACT EMAIL: ,W64 i l n I 1 c@ 43 mai I • cern <br /> AGREEMENT.I hereby certify that t 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!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 /> (Ownerl '•rized ,, , nt Signature ate (Revised 11/5/2018) Page 1-Application <br />