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I ' t (rnc) 0 <br /> ELECTRICALPERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 28201 <br /> (P)425-257-8810 FAX 425=257-8857 f(E),everette eYeretteps@eirerettwa.gov I'w w,everettwa govipermlts <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:2920107th ST SE Everett WA 98028 <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROYMENT 0 REMODEL <br /> BUILDING USE: (✓ SFR 0 TOWNHOUSE 0 DUPLEX ❑ADU 0 MULTI-FAMILY•#OF UNITS:, 0 COMMERCIAL <br /> BUILDING AREA: 2246 sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK'$900.00 ASSOCIATED,SUILDlNG PERMIT#(it applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES:1 <br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans.required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK&CODE COMPLIANCE <br /> DESCRIPTION OF WORK: New circuit:forrACadd on <br /> IS THIS PERMIT EDUCATION,INSrTOTIONAi,HEALTH ANDIOR PERSONAL CARE FACILITIES u No D YES,,saa Betpw&pg„2 <br /> I I By checking this box,I am stating that I have read and understand all of WAG;296.46S-JOO...selected the:specific reason on•page 2 <br /> of this•application(see next.page),AND Plan Review•is NOT required begause I meet.altnf.the foliowng,sub.sections that do not: <br /> See Page 2 require Plan Review, <br /> ARE YOU AN OWNER PERFORMING WORK AS•THE CONTRACTOR:WITHOUT ELECTRICAL.LICENSURE:DNO LYES-See Below&Pg.3 <br /> Pursuant to RCW 19.28.281,property owners and leaseholders cannot perform electrical work on buildings for rent.sale,or lease without <br /> the proper electrical licensing and certification Or exemption_By checking this box,I antstating that l havecompleted and signed the <br /> See Page 3AFFIDAVIT on page 3 of this.application to feeelVe an exemption from this.ticensing/certification.requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME;Kraig Jarman TENANT BUSINESS NAME(If Commercial):NA. <br /> OWNER MAILING.ADDRESS: smrEr2920 107th ST SE <br /> city Everett 98208 <br /> s��� WA <br /> OWNER PHONE:42x6)4g:$-9780 OWNER EMAIL: NA <br /> CONTRACTOR NAINE:GreefWOOd Heating &AC <br /> CONTRACTOR ADDRESS: staeET 825 S Stacy S"[' <br /> CITY Seattle: srntt< WA zp 98134.. <br /> CONTRACTOR PHONE:(206)784.1848 CONTRACTOR EMA.IL:perfnits@greenwoodhealting.+COm t <br /> CONTRACTOR LIC.#(REQutRED):GREENHC84OT CITY OF EVERETT BUSINESS LIC.�#(RECILIIREb Z Ot.A y 1 <br /> PRIMARY CONTACT: DOWNER ( j CONTRACTOR LI (Please Specify) <br /> CONTACT NAME CONTACT PHONE (2Q6)784..18.1 g <br /> Greenwood Heating&.AC CONTACT EMAIL:permits@greenwoodheating.corn <br /> AGREEMENT:t hereby certify that I have read and.examinod thisapplicationand know the same to be true and correct. .otll;pforrision of pies and ordinances <br /> governing this type of work mil be completed whether specified herein or not, The granting of a permit does not presume to give•aulhu my to violate or cancel the <br /> provisions daily other slate or tow/law regulating construction or the pertormance.of construction. That I am authorized by the owner of this property to()Worm the <br /> work for which application is made and comply with the State(ontraaters Law 1827 RCW and 296.200 It tiC:, <br /> City of Everett Official Use Only <br /> PERMIT#> <br /> 1 2/2 7120 18 g\?) 12` (2_, <br /> Owner/ thorizod Agent Signature Date fRevised111512018): Pagel-Application <br /> /3 f <br />