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, <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> 4ETTCITY 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: `/I 6/10 "'" <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION aTENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? b NO ItlYES-#OF DEVICES: 01A-FD�1 9`1/1 y'lili <br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: Vv ` 4' 61/16/141:-k /PrSapifi a )- efie <br /> (5f. itkit/4 <br /> ot4,-(--40: <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <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 /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <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: D11frie 5,4-f51,7,04-1 TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ?i'7 Co/142-V/ RUQ.. d//� /j/�!'Jr� <br /> /CITTY �C�1 `V 11(1 STATE 1 J/'� ZIP 9(I/1V I <br /> OWNER PHONE: 0I-951-Il. /' OWNER EMAIL: YYY ( VV(V/ <br /> CONTRACTOR NAME: 1b15 09ks c.„-kc iy/c� t <br /> CONTRACTOR ADDRESS: STREET `�✓✓✓)/3? 4 L(7/7/0`7 diJf .54‘‘'. <br /> J� <br /> CITY /41:4: 1 1'it€lC. STATE 144 ZIP 17OVia- <br /> CONTRACTOR PHONE: </A49-124,11( CONTRACTOR,\ EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED) ( (457oPf egg Jif CITY OF EVERETT BUSINESS LICQ5 4” <br /> PRIMARY CONTACT: 0 OWNER igK,.ONTRACTOR 0 OTHER(Please Specify)/, <br /> CONTACT NAME: CONTACT PHONE: j?5-.., '�e �O`( <br /> 1� 0)-tCJ1 CONTACT EMAIL: ' �''ea6�'!!'Za5)5R) E/edeik 6A4l4'I7//014-7 <br /> AGREEMENT:1 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 /> ,./ IF <br /> r /7 ///‘? <br /> R(61, \-C6-;- <br /> Owner/Author e, Agent Signature Date (Revised 10/30/2018) Page 1 of 3 <br />