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ELECTRICAL PIRMIT & FIRE ALARM PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> 04Err
<br /> PROJECT SITE INFORMATION
<br /> C E A- q.Q'nQ
<br /> PROJECT ADDRESS: 9505 2 9i'l v . fr0c(,t�i: eAt,7 VeVefl 1 VA- 9fl0v
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT VI REMODEL
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> BUILDING AREA: sq ft
<br /> `__ '' PLICATION INFORMATION
<br /> CONTRACT PRICE OF WO-I :$ yso© A- OCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? n NO • YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
<br /> DESCRIPTION OF WORK & CODE COMPLIANCE
<br /> DESCRIPTION OF WORK:(,,/ ( (ir e l4Ar! T®f h e a,+ I et 6 t1-1, Yts2'e /
<br /> I re;,..- c (. v k pi r 144.0 h 01,1 It4.,/ at,yl J Z. n.ei..,.,- Sp.et.f\r
<br /> Ott 0L,1f0,7 f
<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> ❑ By 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 /> 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/certification requirement.
<br /> CONTACT INFORMATION
<br /> OWNER NAME: , CACI( >c-h t r
<br /> L/ e f et,r1, TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 9503 2_ kid_ Pre e 0wf71 . .si--
<br /> CITY -vexe-1-1- STATE I.d/ ik--. ZIP ,9120
<br /> OWNER PHONE4-I ,_ 2.90 9,f 0 (OWNER EMAIL: ' ' '
<br /> CONTRACTOR NAME: G ..c tj y/ -,o..tef�Y1 t /1d e.kA 6 C/u,i4ey
<br /> CONTRACTOR ADDRESS: STREET 9 e 4 Z Z6-N 57` ,,,/
<br /> CITY i1^ 0 U.YJ. Yl-i gc iz-'G • re ice .fr`e/-"" STATE 1.4,- zi 9f _b 3
<br /> CONTRACTOR PHONE:Z. S't, 7 CONTRACTOR{{-- --�
<br /> EMAIL: Car yvt. � C 01,G �,.
<br /> a s
<br /> CONTRACTOR LIC.#(REQUIRED) L. u,tQ1_, EL 08AIN N CITY OF EVERETT BUSINESS LIC.#(REQ RED):
<br /> PRIMARY CONTACT R , OTHER(Please Specify) To yvt. 61`6 7f
<br /> CONTACT NAME: D, 6 i bb,5 CONTACT PHONE:Li rJ" 2. 10 5f0 ,
<br /> G/ CONTACT EMAIL:
<br /> AGREEMENT'l 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 I am 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 /> PERMIT#
<br /> ,�� 11 f 30/ g
<br /> Owner/Authorized Agent Signature Date (Revised 10/30/2018)
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