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ELECTRICAL PEOI IIT & FIRE ALARM PE11T APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits PRQJECT SITEINFQRMATION PROJECT ADDRESS: O Zic Oef I2 -3S-r c PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE 50UPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: El COMMERCIAL BUILDING AREA: 240-0 sq ft ELEC?RI 1L.A 'PLICATI 11#4,0O MATI N CONTRACT PRICE OF WORK:$ (5294!) ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 'Z10 ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? O ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) - ,DESCRIPTION OF,.WORK&.-CODE COMPLIA E DESCRIPTION OF WORK: cLc rr12.t LA.t - M D Mics---r lay .-cr IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 YES-See Below&Pg.2 QBy 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:5<0 EYES-See Below&Pg.3 J fl 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 OWNER NAME: p/(41,r LA)Ii)Nitia,eS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CIN STATE ZIP OWNER PHONE: Zeta- 7) S.19 OWNER EMAIL: wI7 Not‘4S k �.0'!'�C j. is\1 - CONTRACTOR NAME: 'De__ Curtfl-RlC-_ tt.1 G CONTRACTOR ADDRESS: STREET Z. , ` 1 L " PIP isorsic-\NS CnY goAr,4-rt, c 4C STATE k ZIP i'ga 47, CONTRACTOR PHONE: 20,6• /43.-05E1 CONTRACTOR EMAIL: '9)1,4%1c--pGlE--g fr rt CONTRACTOR LIC.#(REQUIRED):T7C4CLiZ� .92.4 4 T,JCITY OF EVERETT BUSINESS LIC.#(REQUIRED): TIL(, J PRIMARY CONTACT: `OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2/562 - ¶440 652)1 -"D aera. Cit•VrErtr"- --. CONTACT EMAIL: 'q L170 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 t am authorized by the owner of this property to perform the work •r which application is made and t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 1 -, �. �12.439 joir uthorize• nt Signature Date (Revised 11/5/2018) Page 1-Application