Laserfiche WebLink
11 ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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.gov/permits <br /> 457.7 <br /> n��� PROJECT I E I FORMATION <br /> PROJECT ADDRESS: W, • . 7r - _ =.:'. CO A .2D 1 L' S <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT rafREMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> BUILDING AREA: jer _sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ a,63v4ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? FA NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? kl NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: , _.(,V i f'c, 64 :* <br /> THIS SECTION 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-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 INFORMATION <br /> OWNER NAME: J 6.; („c . A TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (/' 7 ('},,,,2. <br /> ri(-2, / Se 9 <br /> CITY k4 kC. �.- /QY STATE R.)A ZIP crd,zS <br /> OWNER PHONE: G��, -,z36 - /O`( 1' OWNER EMAIL: j ki -464- i 1 6? Gt b L. c aV,-\ <br /> CONTRACTOR NAME: Lc,rib Pl P 1 i (C— <br /> CONTRACTOR <br /> GCONTRACTOR ADDRESS: STREET `P"G2j I3/5i- P 1. f . <br /> CITY ! " `6'-"..( C/S()( lie + STATE 0,* ZIP c(-2,,, 7 7 <br /> CONTRACTOR PHONE: t/").5-34-01-77(S CONTRACTOR EMAIL: le-OCctj C. Edi s _1 nl 0 (pin, J. i„wt <br /> CONTRACTOR LIC #(REQUIRED) 1-of )5,_ 2 /4,C177,7?e.;? -c: CITY OF EVERETT BUSINESS LIC #(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CO TACT NAME: CONTACT PHONE: 51(55 i/r) 9 L1 <br /> �r )lj CONTACT EMAIL: lc f // / 1 ` a 7S L . r6 yN, <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 /> PERMIT# <br /> A / 47. 11 _.,tg .( kto - <br /> OwneYorized Agen atu • Date (Revised 10/30/2018) <br />