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ELECTRICAL PERMIT & i IRE ALARM PERMIT APPLICATION <br /> iliNiP _ _ • , Y OF EVERETT PERMIT SERVICES <br /> /4;;007 • 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-857 I(E)everetteps@roverettwagov I www.everattw&govipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5"os— 1,.,)c,20 e , Pi.. Eve/Zell' <br /> PROJECT TYPE: 1:3 NEW CONSTRUCTION 0 ADDITION TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU--.'S:1 MULTI47AMilY-#OF UNITS:418_ 0 COMMERCIAL <br /> BUILDING AREA: 45,047,0 ..s?,Ct sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> ,, I •w <br /> CONTRACT PRICE OF WORK:$ --:,... I. ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 N )... YES-I/OF DEVICESt_3 3 _____ <br /> IS THIS A FIRE ALARM PERMIT? 0 NO YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK& CODE COMPLIANCE <br /> bESRIPPON OF WORK: REPLAe-t.: F ii?..6 ..; *.- ..i6--Tec_r•-• b3rrH , .7v..) " iv' - <br /> I , • <br /> 1 ink Ti- <br /> 4 w NW <br /> THIS SECTION APPLIES TO ALL EDUCATION,1NSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> DEy reciting this box,I am stating that I have read and understand all of WAC 29346B-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 /> DPursuant to ROW 19,2E1.261,property owners end leaseholders cannot perform electrical work on buildings for rent,sale,or lease without <br /> • the proper electrical licensing end certification,or exemption.By checking this box,I am stating that I have completed and signed the <br /> see pir,e 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Sic oTDA c_ 12.61Ne_ ES-MIS TENANT BUSINESS NAME(If Commercial): CA- r-.. t IA c A S. <br /> OWNER MAILING ADDRESS: STREFr 27(32tray 4)tie Igiz.c.)0 <br /> MY 6 vE.R.e.-1-r STATE IA)at vp 9 e6 7c..) ) <br /> OWNER PHONE; 4 Z5 ZS 2 5**htt:20 OWNER EMAIL: <br /> , <br /> CONTRACTOR NAME: 13.4e H P./a-E. <br /> CONTRACTOR ADDRESS: S1RECT Po gem 3711 <br /> --...,„.._....._ <br /> env NIZ.1-twc-,-To t1/4) sun twa Z€P le 2,2_ <br /> CONTRACTOR PHONE: Ai a 5:. 1.-f 1-1 liflic- CONTRACTOR EMAIL: -SIC'F ( . 13/0 P-I f".tat . <br /> — <br /> CONTRACTOR LIC.it(REOURED): ii ZICL..) CITY OF EVERETT BUSINESS LIG 4(REOUIRED): <br /> PRIMARY CONTACT: 0 OWNERMN CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; ti .t-.; VI q iiNc <br /> _...........______ _ <br /> -----s-cF)c ....ge4.75.51t410 CONTACT EMAIL: Sts) c.je_- <br /> . . <br /> AGREEMENT;I hereby cattily that I have reed and examined Ibis application end know itw same to be foie and corroct. All paw/stoat;of laws and ordinances <br /> vicinity this type otwork will he completed whether spettilled herein or nor 'Ina granting of a permit does not presume to Ore authority to violate or cancel the <br /> provisions of any other state or local law regulating construction or the petfounance of construction. Thal lain authorized by the owner of this property to perform the <br /> work for which application is Made and i comply with filo State Contractors Law 113,27 ROW and 21440 WAC. <br /> Oily of Everett Official Use Only <br /> • , <br /> PaRMIT 4 <br /> ......41"-- • 3/thq. <br /> v _ <br /> Owner .Ufilarbed Agent Signature Date (Revised 10/3012018) <br />