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ELECTRICAL PERMIT APPLICATION
<br /> / /44.04/-4' (AIN Of EVERETT PERMIT SERviEET,
<br /> /4/ 'T 3200 CEDAR STREET,EVL.,RET I.WA 38201
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<br /> PROJECT ADDRESS: 3-3 I''t coLsy /Nu I; BUILDING AREA: _ ea ft
<br /> ---— . , -- —
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION-1U TENANT IMPROVMENT r3 REMODEL —
<br /> BUILDING USE: 0 SFR in TOWNHOUSE 0 DUPLEX In ADO g MUT I LEAMILY,•4t OE ITNITS: ____ 0 COMMERCIAL
<br /> eitl,MA%',, , ,.,Tios1171- 7, ON-:84)EOROPTON,Of WORK
<br /> . ., . .
<br /> CONTRACT PRICE OF WORK:$ LI I o ASSOCIATED BUILDING PERMIT#;it applicable): —......_
<br /> DESCRIBE SCOPE OF WORK: cc.E.PLAc-E. )02.6- • , - ba. WITH By.) •A ti, .
<br /> . ,...„—.....,
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY)
<br /> ....
<br /> LINE VOLTAGE WORK? 1;1 NO CI YES-Select Scope: 0 Servi 5i a Feeder 0 Circuils-#: _ ,, U Complete Re-wire '
<br /> LOW VOLTAGE WORK? 0 NO n YES-#of Device
<br /> SELECT SCOPE MEDUIREDI: 0 Data ,13 Intercom CI Thermostat IN Audio 0 Secure Access CI Security System
<br /> -IEI Fire Alarm-Installations under this permit only Include electrical wiring rough-in of the system.An additione!
<br /> Fire Alarm Permit Is required for review of device location and installation approval.
<br /> 0 Other(List Ally 1
<br /> CODE-Com- trrrr s.,. -''-'' '' '
<br /> ‘IS THIS PERMIT EDUCATION,INSTITUTIONAL.HEALTH AND/OR PERSONAL CARE FACILITIES: ti tg7---cryLG sae tioiow 8,Pg
<br /> 0 13y chez this box,I am stating that I have read and understand all of WAC 29S.46B800,selected the specific reason on page 2 i
<br /> of this application(see next page),AND Plan Review is NOT retaiirnd because I meet all of the following sub sections that do not I
<br /> I
<br /> See Pas) require Plan Review,
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO riYES -See Below A Pg :.:
<br /> DPurstiant to RCW 19,26,261,property owners and leaseholdois cermet perform electrical work on buildings for hard,sate,or lease
<br /> without the proper electrical licensing and certficaTiom or exemption,By checking this box.I am stating that I have completed and
<br /> signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification risoulrement.
<br /> ØØrØ ..F:,'-,:. -f,.., : :: .... , _
<br /> . . . . .
<br /> OWNER NAME: 5 IL.cir tue-4 L., 17-EAL esTA-T TENANT BUSINESS NAME It Commercial : C4Ac.16.12- Vs6TP• APTS.
<br /> 'CiWNER MAILING ADDRESS: STREET 27 t2-7 C. -' t Atli: Sri_ 12.00
<br /> -- —
<br /> airy c...v !Le-7 T w;;,t.N.A 20" 121, 524.71
<br /> OWNER PHONE. OWNER EMAIL:
<br /> M.,,.......,......6*.M.I.A.**4...... ., ' ' ....
<br /> CONTRACTOR NAME: g t H Fs RE 1211tiO SEcva.)T•t. L.A.,,c„.„ „ _ , „ --
<br /> 'CONTRACTOR ADDRESS: ::.r144.4,', Pt, Boa( — — — . —
<br /> cm' Pb.2.1...I to —• t..?A , .
<br /> CON TRACTOR PHONE: 42.6 2.1-p-t i Li t-t S" CONTRACTOR EMAIL: __: _EP," e...BfQvi Ftv.e.cow,
<br /> - . ----4
<br /> CONTRAC1OR LIG#REOuIRED. iH V.i12..4Af -,*I-12.14.v.) CITY OF EVERETT BUSINESS LIC.#REQUIRED); .5 (09-7
<br /> PRIMARY CONTACT: DOWNER CONTRAC ION 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ti Z.5 .2).4 141.4s
<br /> ----C-e-P r- are.4)6speto CONTACT EMAIL: ---Z-e r-F G_e t..no f e...e•clam
<br /> A6REFlarEttir -.- 1.=caddy 1 at t hove man and mina-aired ads appkvitino and know Iho acme to be ova and correct ti posw'Mt of =k•if'S rod 0, gave ,-,f this
<br /> type of teed(WM be=Vele whether specified hr)rst or not Me gramme ole permit does tarot presume to give write*is ea;I a I ii 0 r caeorrl the[aversions dairy What state or
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<br /> Mw regurviling Censtruckso or the periormonco of correirection That teen tertertmeeit by me menet of tree properly to perform the work for which vpriorition is made and I
<br /> coniply,wall rho SOB COntracters Law 18.P1 RCW mid 2M.BM WAG. Cl .of Everett Official Use On!'
<br /> VPERMIT if:
<br /> 311,1141 04,v,,.. fil 00,,,,,,5, ,
<br /> Demo" mired Agent Signature h
<br /> tee Page I-Application
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