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F1 EC--rricAt., °.F i 9 ALARM PERMIT APPI
<br /> CITY OF EVERETT PERMIT SERVICES
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<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (F)425-251-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gev€ vnvw.everettwa-govtpermits
<br /> ._. ..:.. PROJECT SITE-8810ON ..„—.. . ..
<br /> (PROJECT ADDRESS: P.. / f .
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION OR DDITION 0 TENANT IMPROVIVIENT U REMODEL
<br /> ODEL
<br /> BUILDING USE: SFR TOWNHOUSE 0 DUPLEX __. ADU MULTIFFAIVIILY-#OF UNITS; t .1MERCIA.L I
<br /> BUILDING AREA:
<br /> CTRI ` ION
<br /> L TI ... ._ON T
<br /> C CONTRACT PRICE OF WORK ASSOCIATED BUILDING PERMIT#(if applicable).
<br /> IS THIS LOW VOLTAGE WORK'? 0 NO ®YES-#OF DEVICES:
<br /> i, IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electnce'and Fire Department inspections are required)
<br /> ,,u DESCRIPTIONOF COMPLIANCE
<br /> DESCRIPTION OF WORK. ! � .. ` , '-i' ,, � �- A ALA i
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<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 WAG 296-46B-900,selected the specific reason on page 2
<br /> 4 ( 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 /> SSP page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this lirnr:s€nglcertification requirement
<br /> II TACT T INFO TI N
<br /> 1 OWNER NAME: 0 j j 't. TENANT BUSINESS NAME Of Commercial):
<br /> OWNER MAILING ADDRESS: s aE T# -
<br /> _
<br /> coy STATE !'+�' ZiPt (I
<br /> OWNER PHONE: 1'�” #.•• l., 11t,, OWNER EMAIL: ;j o (.L `� AA,in
<br /> �.. el 1)1 -Li Ls 4 -t,,..-f,.„ r `i "ir'
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET ` 1 '1` (f,. s
<br /> cm 12
<br /> G^^�G/ o STATE ' ZIP 1162-1162-(-"6.
<br /> CONTRACTOR PHONE:I0ii)l" 200 l&' CONTRACTOR EMAIL: N)I IkO &14& iv).6 Vrv}
<br /> CONTRACTOR LIC.#REQUIRED):i `a A 4 ')2- , , CITY OF EVERETT BUSINESS LIC.#REQUIRED: ,y
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:(,7y }� 214)(21
<br /> y �t 1 ` '✓ -ice
<br /> t� � �# � CONTACT At ;1
<br /> AGREEMENT Ihereby certify that I have read and examined this application and know the seine to be.true and correct All pr rvistons of fav s end ordinances
<br /> governing this type of wesail be completed whether specified herein or not. The granting orf a permit d not presume ter give authority to violate or cancel the
<br /> prow's/et/sof any otstattte or local law regulating construction or the performaence of co ruetrcor �r euttrad by the Mawr er of itis prcperfy dorm the
<br /> work for t/bn is mode end I comply with the State Contractors Law 1827 c :„ i° � i,
<br /> ti. City.
<br /> „Everett, Fa Use
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