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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 E)everelleps@everelivva.gov I wwviLeverettwa.govipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 20 9.) Vi(01.,Va at AVE' 11&Vttq--zol <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT <br /> BUILDING USE: CeSFR 0 TOWNHOUSE 0 DUPLEX 0 ADU .0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> CONTRACT PRICE OF WORK:$ (COD TASSOCIATED BUILDING PERMIT#(If applicable): <br /> IS THIS LOW VOLTAGE WORK? NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? ' NO 0 YES Plans required for review(Both Electrical and Fire Department inspections are required) <br /> 00CRIvis TIONZOP WORA4404.1*.40011!"..14NPE <br /> DESCRIPTION OF VVORK: '2.1) 01 (Ayovtit <br /> IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH ANDIORPERSONAL CARE FACIUTIES: 0 NO DYES—See Below&Pg.2 <br /> r---1 By checking this box,I am stating that I have read and understand all of WAC 296-465-900,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 /> SeePage 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:,ONO OYES•,Site Below&Pg.3 <br /> DPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electricalwork on buildings for rent,sale,or lease without <br /> the proper electrical licensing and certification,or exemption,By checkirtg this box I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of thisapplioation 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 20 (9) ( <br /> CITY sTATAA/A- zParce2-. I <br /> OWNER PHONE: 4e1 OWNER EMAIL: Y‘<( <br /> CONTRACTOR NAME: Ill titrYkk" LC-611i <br /> CONTRACTOR ADDRESS: STREET I ,D n111. <br /> crry t. tte/VrAn STATE j/V UPI 9-2-5C3 <br /> 'CONTRACTOR PHONE: 4-2. 11/470-52.4ONTRACTOR EMAIL: i‘ ALt A-tg . itA t <br /> CONTRACTOR LIC.#(REQUIRED): f\I ii-o.4'e5161Q& CITY OF EVERETT BUSINESS LW.#(REQUIIIED): Y4 -( (orb. <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0.0THEli(Please Specify). <br /> 'CONTACT NAME: ecA2 CONTACT PHONE: 1-125 -I Co 0 -32.,c) <br /> CONTACT EMAIL: t'CS. C4) <br /> AMMO' <br /> AGREEMENT:I hereby certifythat I have read and examined Ibis application and know the same to be true and cornea/Al!provisions of laws and ordinances <br /> governing this type of work will be completed whether specified hernia r not. The granting of a permit does not presume to give authority to violate or cancel the <br /> provistonaof any ottler state or local law regulating constnictOn orthe performance of construction.. That am authorized py the owneroithis property to perform the <br /> work for which application Is made anti comply with the State Contractors Law 18,2r RCWand 298.200 WAC. <br /> City of Everett Official Use Only <br /> I PERMIT it . <br /> /ID/le) <br /> Scanned with CamScanner <br />