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ELECTRICAL IIIRMIT & FIRE ALARM P1RMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
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<br /> '40440;7?-'
<br /> 4 _ 3200 CEDAR STREET, EVERETT,WA 98201
<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: ( At,
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<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT,REMODEL
<br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> BUILDING AREA: sq ft
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<br /> CONTRACT PRICE OF WORK:$ 1,0ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? ONO 0 YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? / O 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: Re P(ace,wwvti,A°f- ea( . FCO: ,` C ,01,.ts.s
<br /> THIS SE ION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> rr By checking thisbox,I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2
<br /> Wk. 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 /> S e 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 INI�`OIi RATION
<br /> OWNER NAME: 7r6:;r gt5 ia,-cliect TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET /5L0 i”kce, 1 i c� i v_ .544...1.544...141O/ � ^�
<br /> CITY A e, STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: V ECA C� ck _ /, a(d GS
<br /> CONTRACTOR ADDRESS: STREET S—LA. " AJtc
<br /> CITY gC.G_` 14e STATE A111- ZIP / r�
<br /> CONTRACTOR PHONE: Gn 4434?-5-2b 'CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): �/ ���(, _ i., (CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OOP'S(j
<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR PA •THER(Please Specify) •9".i U. 4,4vleru‘ Fo e£444et�7
<br /> CONTACT NAME: CONTACT PHONE: 2--06, °— Sgo---9155
<br /> & _eu.,,x /". CONTACT EMAIL: Sb , .5444, fc.L 0.. VE:c4.cz
<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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> -z"( PERMIT#
<br /> A n Si na ure /ati Revised1008 ae1 of 3uthed geg ( ) � 9
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