1929 WALNUT ST 2019-07-09 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SER\ S 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 {(E)everetteps@everettwa.gov I www.everettwa.gov/permits { PROJECT SITE INFORMATION PROJECT ADDRESS: IO2.dl V\10kkVl� t Ut to, 01(620l PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT rREMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 7 O DUPLEX ❑�4DU Iffl MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: lZ(U sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ '2:77 -- ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? NO `£I ES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 0 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE �COMPLIANCE DESCRIPTION OF WORK: CUIMp\gte � �, I�'Q,{�f iiia t yTerve 2 jpt THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: laBy 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: ® Pursuant to ROW 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 C/ requirement. • �,/ / / CONTACT INFORMATION OWNER NAME: P t v 1 t2t 01 v'ti V1 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1617-II NOUVI,vit 4+ yj}�` crry �"�j'Y? STATE Aft ZIP l f2vJry-�/n I OWNER PHONE: Y\ ( A _OWNER EMAIL: IA/t CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET [GJ O 141 ti 1)2_ 5 E Cn~ L-8Lke Gt1 Civ15 p STATE ' •VZiP ��Z.-�� CONTRACTOR PHONE:4'2J LQO "J2 OOCONTRACTOR EMAIL: IV V jVVVV I-tvS�C to I • (X)--m CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: WNER CONTRACTOR [OTHER(Please Specify) CONTACT NAME: '/ �� CONTACT PHONE: 42 l 1u 0 ?j 20�J CONTACT EMAIL: t V ec(V(\cls ovyw , 1 AGREEMENT:I hereby certify that!have read and examined this application and know the same to be true and correc. All provisions of laws and ordinances 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 provisions of any other state or local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and!comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 1111,4#11 1715/(g. Owner/• ho rd Age i nature Date (Revised 10/30/2018) Page 1 of 3 A ...:i6. P`.,...0 ..