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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 4re77(P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> CPROJECT.SITE INFORMATION <br /> PROJECT ADDRESS: ( �c:r✓ I.. 1 1— 1-:' tiCiL'I--I— 6,i4 ( CC26l <br /> PROJECT TYPE: ❑NEW CONSTRUCTION 0 ADDITION ,TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> BUILDING AREA: sq ft <br /> • ELECTRICAL APPLICATION INFORMATION : - <br /> CONTRACT PRICE OF WORK:$ 5O(- t- (ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE' <br /> ( <br /> DESCRIPTION OF WORK: o is x i- C«(X � Li <br /> Ge) 1?)Lt-tVe r ( / (i4 4 cit' It S <br /> THI SE N 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: d r1 e- j\ <br /> 'Prd 5;c•t, N, A-t ,e-‘:( TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I 0 L /tA /I,:_ to - JO/� <br /> CI Y Kt 1 fdtit STATE zJP ce. J 4 <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR NAME: V EciA c.lam_`c <br /> CONTRACTOR ADDRESS: STREET CO'14 }-*'t "4, S <br /> CITY S'eci. (_ STATE L'- 4 ZIP qe lC E, <br /> CONTRACTOR PHONE:213(0 —1(36 - a2-61) (CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):V.E 12/) t_CZ i y?MO [CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C.O '-fes '-rj <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR <br /> OTHER(Please Specify) 1-:L tc: ex,,,,{,( r ur c s'"<<-1 <br /> CONTACT NAME: CONTACT PHONE: c' coe <br /> ,spls.014 so,,,,,wtl CONTACT EMAIL: gI <br /> �Sc7^t� ScSttc^cn3i..r>'1,� Vt-c'/4. {':5,4-i <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 /> it 2 /6 ac6A <br /> \-1)I ,Tz --_ <br /> O er/AuthoriAgent Signature <br /> ate (Revised 10/30/2018) 'Page 11 of 3 <br />