2726 PINE ST 2019-04-29 - Laserfiche WebLink

ELECTRICAL PMIT & FIRE ALARM PIIMIT APPLICATION @Ajen- CITY OF EVERETT PERMIT SERV ES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 2l Z e a I f e S± Ev-ey-ems- 1 WA (7k b2 Q I PROJECT TYPE: ['NEW CONSTRUCTION El ADDITIONlifII TENANT IMPROVMENT 1REMODEL BUILDING USE: i W.FR 0 TOWNHOUSE 0 'UPLEX I❑ DU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: sq ft s „m - . Cry" ► " NF I� ." N , CONTRACT PRICE OF WORK: $ t(2)0(2 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? "i NO ❑ ES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 12 0 ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) - a 71V VAx Na i.R DESCRIPTION OF WORK: k—V ow 4. \ik 7€ IC, ��t QtI�s ( _- a.Ifi C ►V�itit it),,,. THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: IrlBy checking this box, I am stating that I have read and understand all of WAC 296-4613-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: I■� Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption.By checking this box, I am stating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. y t _,_ .. ti.....r, / . .:.: . ', iy - vsitt 1ofto . 1$ wc.44 j 4 pm, " s, , ,*';ani OWNER NAME: AMOKOSI O1 Dick- TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2 T2 J Piot' ks t CIT /� /I r ( Y V v Y-e-w STATE W A ZIP —O I OWNER PHONE: 42"✓ t-7"34 _I YM OWNER EMAIL: V\I al CONTRACTOR NAME: I in Rouse ous li . t-cU t V ( col S e- V I VV✓ i \ in • CONTRACTOR ADDRESS: STREET /'��Ir/�0r�\+1I�7A/ D1� SL /� fin} CITY (/V 1 I-V gt V 1� S STATE V �/3 , ZIP q9)2—(3 I CONTRACTOR PHONE:1:20 7(oo 'l Z CONTRACTOR EMAIL: i lr-epf 1ff1r1"S�g V I All . vV al CONTRACTOR LIC.#(REQUIRED):( j H OV I E q02. (/1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044112 PRIMARY CONTACT: 0 •WNER r ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: 14.1 CONTACT PHONE: 1.4--2_� - D ' 2...0,72 CONTACT EMAIL: i VvC/1).-Cand—S �tG Wad I , arm AGREEMENT.I hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of law and ordinances 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',i'late or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of thi:',_�roperty to perform the work for which application is mad-and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett O0;la!Use Only PERMIT# • /\__. /2-14// 01, ( Own lAutho ize' • ,-nt S": ature Date (Revised 10/30/2018)