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<br /> ELECTRICAL PitMIT & FIRE ALARM PEttlIT APPLICATION
<br /> 011)N111)!..- , CITY OF EVERETT PERMIT SERVICES
<br /> , �- 3200 CEDAR STREET, EVERETT,WA 98201
<br /> • (P)425-257-8810 I FAX 425-267-8857 1(E)everetteps@everettwa.gov I www everettwa govlpermits
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<br /> PROJECT ADDRESS: (I6 ?GGi-•C 4%)E -ver-e+.1- GI)4 320`
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION 0 ADDITION TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU ❑MULTI-FAMILY-#OF UNITS: C OMMERCIAL
<br /> BUILDING AREA: sq ft
<br /> MMWASIVAMWRA
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<br /> CONTRACT PRiCE OF WORK:$ OI 000 'ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THiS LOW VOLTAGE WORK? 0 NO 0 YES #OF DEVICES:
<br /> iS THIS A FIRE ALARM PERMIT? NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: -1-- d- 4 i p L 6r-- f iti.) of eoloov pai'1 / 'ax,—,
<br /> .- c. Pec.ic_ovIL,1
<br /> i e_ (..... (-- 5.c.,
<br /> THISSE ION 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 WAC 296-46B-904,selected the Specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required because 1 meet all of the following sub sections that do not
<br /> ee Page 2 require Plan Review,
<br /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMiNG'WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:
<br /> i
<br /> iPursuant 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 /> OWNER NAME: IFr wItle%ic� moire=tat A We O4 TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET i€ > Lt.4 4V E-
<br /> ar(
<br /> CITY '�q1 r, je i STATE (NK ZIP /SIC) )
<br /> OWNER PHONE: 'OWNER EMAIL:
<br /> CONTRACTOR NAME: t/ E-tecri"iG
<br /> . q
<br /> CONTRACTOR ADDRESS: STREET 542(I( 4441 i✓
<br /> CIN .S-�444STATE W X7 zip /e e)
<br /> CONTRACTOR PHONE:2A,-456-5-Zoo 'CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): 4 GZ Sq A4LJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): N +{'4
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ri6THER(Please Specify) t=<c(c 6cAcra,( 6r ,,-7
<br /> CONTACT NAME: CONTACT PHONE: 20, 950-- 3e,
<br /> ( Wee rc j ( CONTACT EMAIL: S,rjyt.Sc ec,,v4a le IOcCry.c ©"1-7
<br /> AGREEMENT.t 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> 2/'V/� 002 0 q
<br /> /Authorize Agent Signature ate
<br /> (Revised 10/30/2018) Page 1 of 3
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