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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320.0 CEDAR STREET,EVERETT,WA 98201 <br /> e <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps© vereftwa.gov1 www.everettwagovipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Qq D.% -- -31ra <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT INIPROVMENT g(REMODEL <br /> BUILDING USE: I:a-SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> , <br /> ELECTIXICAL APPLICATIOt41141FORMATICIN, <br /> CONTRACT PRICE OF WORK:$ Li, ,LA — ASSOCIATED•BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? i;rpc, 0 YES-#OF DEVICES:* <br /> 19 THIS A FIRE ALARM PERMIT? [ 'NO 0 YES Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OP WORK&CODE COMPIJANCE <br /> DESCRIPTION OF WORK: 1Nr,AA JetoccC ‘rt" ir‘1 ctLf \ \A,ts 4(L0, t r <br /> ) <br /> ti...3ct ea IPS. <br /> J‘k, <br /> $THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO DYES—See Below&Pg.2 <br /> I-1 By checking this box,1 am stating that I have read and understand all of WAC 296-468-900,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 /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: OYES-Sep Below&Pg.3 <br /> DPursuant 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 an page 3 of this application to receive an exemption from this licensing/certification requirement, <br /> CONTACT INFOIRIVIATION' <br /> OWNER NAME: \,)'1 (f),„f4',) 4- TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: MEET % <br /> CITY Eve,op,A4-- STATE 10 01V63 <br /> WNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:LIG-MBA/11TH ELECTRIC LLC <br /> CONTRACTOR ADDRESS: Si REEr6619 132ND AVE NE(PMB#255) <br /> ciry IIRKLAND STATE WAzi98033 <br /> p <br /> CONTRACTOR PHONE:425-825-5552 CONTRACTOR EMAIL:OFFiCE.LiGHTSMITH@GMAii.COM <br /> CONTRACTOR LIC,fkREQUIRED):LIGHTEL-825RF CITY OF EVERETT BUSINESS LEG.AREQUIRED): 58579 <br /> . - <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-825-5552 <br /> JENNIFER CONTACT EMAIL:JENNIFER.LIGHTSMITH@GMAIL.COM <br /> AGREEMENT:1 hereby certify that I have mad 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 ION 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!am authorized by the owner of this property to perform the <br /> work for which application is made end I comply with the State Contractors Law 18.27 RCW and 298.200 WAC. <br /> City of Everett Official Use Orily <br /> PERMIT# <br /> 3( to f(61 <br /> VCt,0 3 -414 <br /> (.-----)10,:\mdAukulthori ant Signature Date (Revised 11/5/2018) Page 1.Application <br />