3311 WETMORE AVE VISITING ANGELS 2019-05-22

ELECTRICAL PER=M' & FIRE ALARM PERMITOPPLICATION 477CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 33 // W('--(-/Y er c- w PROJECT TYPE: nNEW CONSTRUCTION ❑ADDITION INTENANT IMPROVMENT ❑REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE nDUPLEX 0 4DU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: 36'61) sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 6 /7,00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO EYES-#OF DEVICES: 30 IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: j-j g UC7 t)tZff p,4-7-/ a43.7- L/III .3® C od.7-4/piir THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: UBy 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 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: DII DI 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. CONTACT INFORMATION /t OWNER NAME: TENANT BUSINESS NAME(If Commercial):4/7-5// /n/G- .4.t/G s OWNER MAILING ADDRESS: STREET 33 /1 k1 1 i A-v� • CITY ///"' e.// STATE 14-24 ZIP OWNER PHONE: OWNER EMAIL:� '/ CONTRACTOR NAME: Ne Cep 7--EcII ( )AImHIOH/GAT/DMc //I/C CONTRACTOR ADDRESS: STREET r U2o) // 2 CITY /1 (. C/L iZ STATE 44--2,4 - ,/4 ZIP '7 q.2 7S-- CONTRACTOR c-CONTRACTOR PHONE: yZS"-Zj /7-76A3 CONTRACTOR EMAIL: JIM kA te. .s- e."& crh 6_0~4,6e41 CONTRACTOR LIC.#(REQUIRED): Aft k1 TECH j /Ice J4. CITY OF EVERETT BUSINESS LIC.#(REQUIRED):,330 347 PRIMARY CONTACT: [OWNER 'ONTRACTOR EIOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: i/Z .3c/7.7Gz 31114 i gi.(?1i CONTACT EMAIL: ,//i1 f t/4.r 4sgA/&,7 161 6m/rq, [i yy/ 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 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 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 work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only / PE # //-7,z423 `,ISI I-6 � •Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3