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ELECTRICAL PERMIT & FIRE ALARM P - IT APPLICATION <br /> ,IIIIP CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA,98201 <br /> (P),425-257 10 I FAX 425-257-8857 1(E)everetteps@evereftwa.gov i .e ereitwa wirer its <br /> PROJECT SITE INPORMATION <br /> PROJECT 14 e ms; ' <br /> PROJECT TYPE: 0 NEW CONSTRUCTION ADDITION 0 TENANT IMPROVMENT geREMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU k. MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK $ 5'' — ASSOCIATED BUILDING PETIT#(if applicable): <br /> IS THIS LOW.VOLTAGE WORK? igrr 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? l'NO 0 YES-Plans required for review(Both Electrical.and Fire Department inspections are required) <br /> DESCRIPTION F WORK& CODE COMPLIANCE <br /> DESCRIPTIONOF WORK:: _V-.,.(yifi/-4., k 4 c � <br /> IS THIS PERMIT EDUCATION,INSIT'UTIONAL,HEALTH AND4OR PERSONAL CAREFAGS-RIES. NO 0.Y E--See Below&Pg.2 <br /> checking this box,I am stating that I have read anti understand all of WAC 29S-46B-900,selected the specific reason on page <br /> of this application(see next page),AND Plan Review is NOT requited because I meet all of the following sub sections that do not <br /> See Page 2 require Pian Review, <br /> ARE YOU ANOWNER'P ORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL L.IENSU :, OYES-See Below&P .3 <br /> El Pursuant to RCW 1928281,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;t 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 licensinglcertification requirement <br /> CONTACT INFORMATION <br /> OWNER NAME: klyk, v{.., \i,:\;\' ..Q,„,--. ,t. TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS; smear ° CI1 4'{ t 1 del ;ti ( flt-� a <br /> ca, R, ° srnm ZIP q t) <br /> OWNER PHONE: 3 " j 67:Y1,(9, <br /> `:Y1,(t, OwNE -EMAIL: <br /> CONTRACTOR NAME:LIGHTSMITH ELECTRIC LLC <br /> coNTRAcToRACORESs: s-reeeT6619 132ND AVE NE(PMB#255) <br /> CITY`KIRK D SLATE WA zIP `'a.# <br /> CONTRACTOR PHONE:425-825-5552 ,CONTRACTOR EMAIL:OF ICE.LI HTS ITH GMAK OI I <br /> CONTRACTOR LW. REQt IRED):LIGHTEL8: RF -CITY OF E EIil 7T€USIN SS MC.if(REQUIRED): 58579 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:•425-825-5552 <br /> CONTACT E ENNIFR.LIGHTMITH . MAIL,C:ONi' <br /> AGREEMENT:I hereby certify that:lhaveav read and examined this application and know the satire to he Mie and correct Aiiprovisions of laws end ordinances <br /> governing this type of work will be cohrpieted whether specified herein or not The granting of;a pent*does not presume to give authority to violate or cancel the <br /> provisions of any o her state or local law regulating construction or the performance of construction. That lain authorized by the owner of this property to perforin the'. <br /> work for which application is made and I comply with the State Contractors Law 1&27 RCW and 298,200 WAC <br /> City of Everett Official Use Only <br /> ° PERMIT <br /> 1 1 ? c I $1 a — �9 Q <br /> (Illt.WAIAL' <br /> d Agent Signature Date (Revised 111512018) Page 1-Application <br /> i <br />