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w�II <br /> .1 <br /> ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> ,I.Pz_% ----A CITY OF EVERETT PERMIT SERVICES <br /> -006 <br /> _ 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: as 10. 6.--J- <br /> PROJECT <br /> TYPE: 0 NEW CONSTRUCTION 0 ADDITION OTENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: ASFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /i ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 'ET NO 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 /> DESCRIPTION OF WORK CODE COMPLIANCE <br /> DESCRIPTION OF WORK: ,{p:•/ �� -U/�' ' / <br /> r-144-j../. 4`--i-'_4 Q I <br /> ip <br /> ciii6,,,,goix CA A Al. .!_.1_ _ A :0 .1.-A Lag-..e/P <br /> SI <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> 1:1 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: TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> S <br /> CONTRACTOR NAME: �le� C; G, • Ito <br /> CONTRACTOR/ ' ADDRESS: A . , STREET ® r 64( ✓,9� <br /> -p-e0f ``f 4- /\CITY Lc) /)=-- STATE ?fcZIP <br /> CONTRACTORrOOOVVV�RPPHH�`OONNE: �Id1��)"--4 Qt I--4 eCONTRACTO EMAIL: \3 W,P an yt@ &011, <br /> CONTRACTOR LIC.#(REQUI•RED): W ieeziE T (alp/J CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1 <br /> PRIMARY CONTACT: 0 OWNER p enNTRACTOR 0 OTHER(Please Specify) <br /> CONACT NAME: CONTACT PHONE: /-440 T <br /> OW'"\\--- CONTACT EMAIL: \ �1 "C"--a VEL4. J11 (A)j /4 4414 /k <br /> AGREEMENT::I hereby certify that I have read and examined this application and know the same to be true and correct. A 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 app' 'on 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 /> alohip. <br /> ���/ /1 e <br /> - -ige <br /> PERMIT)# <br /> Owner/Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3 <br />