8408 18TH AVE W 2019-06-05 - Laserfiche WebLink

ELECTRICAL F3IRMIT & FIRE ALARM F RMIT APPLICATION °J7ETT. 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 I www.everettwa.gov/permits p� �, IPROJECT�OSITE INFORMATION PROJECT ADDRESS: 4 O V \Qb 1�V 1'1 Q IN Wei1PJ-1"F , VUR O\Q o4 PROJECT TYPE: nNEW CONSTRUCTION [1ADDITION ❑1TENANT IMPROVMENT IIREMODEL ' BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 4DU MULTI-FAMILY-#OF UNITS: q) 0 COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ (4- V ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? '® NO ❑ ES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? El NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: P,Qp I. (e) IA Vl l t Q(tj(V"hilaeA/l fi ServiGQ THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: la 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 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: Ell 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: P21 C/ 1 Pal v/\Ci✓ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET (?)4p-�O Q 17 1 AV C IN CITY r��/r -4 STATE �/,f� ZIP CI 9320 OWNER PHONE: 42-0 2-1---4I '✓63 OWNER EMAIL: n' G( CONTRACTOR NAME: ( Vt HOLA5e -E l-0&tVl(j n CONTRACTOR ADDRESS: STREET I�/�/".Q0 1 \��/1��D1? 'CV- „Ty C (� n` CITY VA rV S� cA l=7 STATE �I ZIP q?J 2 `U CONTRACTOR PHONE:42L 11.2 0 '32 0 CONTRACTOR EMAIL: (Ir\q-/yyv rt S @ 1 at/I I . Gen/Y1 CONTRACTOR LIC.#(REQUIRED): I I\i HOIA t S ”✓Z &G�j CITY OF EVERETT BUSINESS LIC.#(REQUIRED): p 414 a LQ(q) PRIMARY CONTACT: rEOWNER 1 ONTRACTOR nOTHER(Please Specify) - CONTACT NAME: CONTACT PHONE: L-I-2 G) GJ3O -7 oi7 ILeiSPitJ/ I �� V� its CONTACT EMAIL: ��/ @ g 1714 A.A ( (4, yr, AGREEMENT..I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws,a 71 ordinances governing this type of work will be completed whether specified erein 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 rf gulating construction or e performance of construction. That I am authorized by the owner of this priperty to perform the work for which a ca .n is made and//comply wit - State Con actors Law 18.27 RCW and 296.200 WAC. / City of Everett Official Jse Only / PERMIT# ----- " ' ///2(a/(e E__ \ S l. — S T-1 Owner/Authorized Agent Signature I Date (Revised 10/30/2018)