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S., <br /> ELECTRICAL "iir- MIT & FIRE ALARM PA/11T APPLICATION <br /> 4CITY OF EVERETT PERMIT SERVICES 1/11 '006111"P" <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gav/permits <br /> PROJECT SITE INFORMATION PROJECT ADDRESS: ...5—/O ; ?"44, _.l, _ 1 <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ril ENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: 4 3 0 o sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> . <br /> CONTRACT PRICE OF WORK:$ j ` <) ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? r;,....5—<)C..) <br /> NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? 10-116— ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK 8, CODE COMPLIANCE <br /> DESCRIPTIO OF WORK: tD0\-0))61 IQ't V k t cS 4- )-}ak u-P iii-ck _11.1- , <br /> i<vtzmA -RXTS c • �i-CZE a- C-� �, <br /> G - fR, - w t, Q 'J t CLQ <br /> IS THIS PER ITEDUUCA�TION,INS ITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: 6i 4 ❑YES--See Below&Pg.2 <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 /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: QI,M6 OYES-See Below&Pg.3 <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 /> S <br /> Q CONTACT INFORMATION c <br /> OWNER NAME: Pt-- J <br /> - 1 3 � BUSINESS NAME(If Commercial):/�� `(-s.'.G�A.cip_ <br /> OWNER MAILING ADDRESS: //�, STREEJ/T�\ <br /> 5 C , C J CITY��{F"r�1 ) STATE ZIP _- <br /> OWNER PHONE:(") J i4( , 4`_' VER EMAIL: <br /> CONTRACTOR NAME: 'i CR/AS-1;k �, y'.( <br /> CONTRACTOR DDDR/ESS: /T��� � u., 3 , ,*.kaz. <br /> p:) ..,�' LQ�/ cn STATE Vi ZIP ad <br /> CONTRACTOR PHONE:( )3544 EMAIL: J t� t UQ41 <br /> CONTRACTOR LIC.#(REQUIRED): t =z.'ZQ S1 CITY OF EVER TT BUSINESS LIC.#(REQUIR. - , . .,, ., �� <br /> 1 <br /> PRIMARY CONTACT: 0 OWNER V 9 ACTOR 0 OTHER r -ase Specify) <br /> CONTACT NAME: CONTACT PHI E: (2o6 73" 3 2_. / , ! <br /> IP, <br /> L) � CONTACT EMA • V J a'u A 0t n ou <br /> AGREEMENT:/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 thispropertyo perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WA C. u Iv hi <br /> t Oft1e(a etly <br /> PERMIT# <br /> 0.2 '--/7'18 c' i lia - D4 (.9 <br /> 1.*1'"uthori -• ••rnt Sig ire Date (Revised 11/5/2018) Page 1-Application <br />