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<br /> ELECTRICAL PMIT & FIRE ALARM PER/11T APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> #411 PHA •At'
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: I g I'\ t &' ¶ 4 Evexx, -� W 4 9€3 2._e)
<br /> PROJECT TYPE:IgNEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 7l.COMMERCIAL
<br /> BUILDING AREA: sq ft /
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<br /> CONTRACT PRICE OF WORK:$ IOnacos—
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: O•+r ers r-casrq .o+1<].t c t-�- �a r p t C,' dairkJ r
<br /> Va t o 1' IDCZA I e t_ t9(r,,-e_ C 4,ifM ave t C i e 4 S
<br /> co-w,Gl Po.e,'\ L.ecjt4 vvi C,eci.4r .i (� t,' r�(ted.-r Per k .-1
<br /> THIS SECTION APPLIES O ALL EDUCATION,INSITUTIONAL,HEALTH ANb/OR PERSONAL CARE FACILITIES:
<br /> ❑
<br /> 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 INoottni TION ,.
<br /> OWNER NAME: err-b je Act_ Res,-..n.( TENANTBUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET % }O\ L',Ac( 44.1 4Iv1 4161 , / /J
<br /> CITY R(dl,i-0/\ STATE l )4 ZIP TOS-4-
<br /> OWNER
<br /> O j4OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: V ECA- ak PCL 00 45
<br /> CONTRACTOR ADDRESS: STREET g-4 l Li -4.1-4 +� S �+
<br /> CITY STATE 4 ZIP / (DA
<br /> CONTRACTOR PHONE: `LOG t t— 120.0 CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED):VEC.o4 C 3"12-I U CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ' �j S
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR gOTHER(Please Specify) 6eitr4( rde '
<br /> CONTACT NAME: // CONTACT PHONE: 2.0(p, $�j'p . 30
<br /> S Irl t4c /d, CONTACT EMAIL: �cwrrN 34 4.4414 �ilf�C .C034-t
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All 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 application is made and!comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ner/Authorize Agent Signature Date (Revised 10/30/2018) Page 1 of 3
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