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<br /> ELECTRICAL R
<br /> NIIT & FIRE ALARM PERMIT APPLICATION
<br /> ,,--�- CITY OF EVERETT PERMIT SERVICES
<br /> I"` 3200 CEDAR STREET, EVERETi,WA 98201
<br /> ifriw (P)425-257-8810 j FAX 425-257-8857 1(E)everetteps@everettwa.gov] www.everettwa.gov/permits
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<br /> a4YsSss �- 2 , z. 2. .' Y4 nh81 .r4r»�* ..a.a<, y-u *c- a* �- ,^-� ... >`� b g,:: oc:
<br /> PROJECT ADDRESS: t 330 ROC k (lcr— Avg Ei r • !/)4 ,•eZe r S-141 !-
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITIONENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNiTS: COMMERCIAL
<br /> BUILDING AREA: sq ft
<br /> V ai/ iiti it § M y,,�: kms-AV�- �.
<br /> �..t-.:,,'t Yom.x..u?:}6x a., ,moi...'.rv,.., rec,,.n.;rxt<.ur�.hta lr,-x.�.� , �a3 'S.... ..._ �A �s,2;k- 1't �E,,,#.3 e� A„�'{x � S4
<br /> CONTRACT PRICE OF WORK:$ 5, e4tj ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? -I 0 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 /> x£ . ag@t c vgeeae� :* y. Ec aKA)Y,,V14r�V.,s Pw . `*fh`xIY ����rag3 REDESCRIPTION OF WORK: Si".�c, Dc '"4 kekAresccetf i /...:E 1Cf- +1
<br /> fvvi 3 +"t o3" �CC '�) .
<br /> 51% floor- $,,,-1-L S 6
<br /> THIS SECT ON APPLIES TO ALL EDUCATION,iNSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> dizBy 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 /> D
<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/certffication requirement.
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<br /> ..r..... .. ,.aa:.'.S ...:h.x .. �,!e.._'s'rc a'._c..v._r M,n,.TS,Y�..,M^. 2 a.-� Mf � "2 d � �'
<br /> OWNER NAME:Prs++;Ci&a. P_e5+0'14( /I+tet[i ( TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET IQ I. 1-4--'t a All ,Scry) * )' d6
<br /> CITY Pzvt.fi7V1 srATE ‘0,44J
<br /> ZIP 80S-7-4-
<br /> OWNER PHONE: LOWNER EMAIL:
<br /> CONTRACTOR NAME: VECe ttectr c- of- I ec tt 645 L
<br /> CONTRACTOR ADDRESS: STREET .5-(?14 7"4
<br /> Y 5
<br /> cm' 144L. . STATE A,...34- ZIP 16/OA
<br /> CONTRACTOR PHONE:206 -if3 L S-4-00 ,CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC. REQUIRED).tri C4 EG.I• is/AL; CITY OF EVERETT BUSINESS LIC.#(REQUIRED): t1O �'V im'
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) t- �
<br /> C2 .1 hDres.141
<br /> CONTACT NAME: CONTACT PHONE: 2®6,—ow_...-41..;d.
<br /> SaLocyt„t,(4 CONTACT EMAIL: Atrs,tja ''- • olvaalc rte►, v, . ce)bin
<br /> AGREEMENT:I 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 lam 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 /> ,0"/
<br /> eriAuthor d Agent Signature IPE! 11
<br /> Date (Revised 10/30/2018) a e 9 of 3
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