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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> _ (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> 4*.rr <br /> IPROJECT SITE INFORMATION <br /> PROJECT ADDRESS: i t.pt L) 12-l‘- :,:j-t-- SE II 'Vti'1 U-1- <br /> PROJECT TYPE: ❑MNEW CONSTRUCTION ADDITION ❑1TENANT IMPROVMENT REMODEL <br /> BUILDING USE: [SFR T OWNHOUSE TODUPLEX 1ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ( ; ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? ❑ NO D YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? ❑ 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: 'lip( k f - `c)�� e _ 4u-,c( ts- /d- . <br /> k• ilkevutt&I- <br /> THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> DBy 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: ,-)\\L_V\ J(,l. . t4L L) TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 400 12-I�-r r'S- ' (7 *It <br /> V\h t ti C)9A f� <br /> nCITY 2`�1„ .A\ STATE A. ZIP CR LUg <br /> OWNER PHONE: 1A' • `Tj• j��(7OWNEREMAIL: _ ( ,, <br /> CONTRACTOR NAME: gal �1.\ "RtAIIN <br /> * 1 1 N Y UC l�+�M� &� D W <br /> CONTRACTOR ADDRESS: STREET PO 8rb 1 Cl$ <br /> CITY AAIX�t/l u \ STATE kik, ZIP 1t2-9-0 <br /> CONTRACTOR PHONE: tQ�V <br /> • L . bC CONTRACTOR EMAIL: i i'\'"t?7) ( �_eA. ZAP V a~ 11 , 1 <br /> Q <br /> CONTRACTOR LIC.#(REQUIRED): • {C KS1p3K" CITY OF EVERETT BUSINESS LIC. REQUIRED): Do -jR <br /> PRIMARY CONTACT: El OWNER gONTRACTOR nOTHER(Please Specify) <br /> CONTACT .NAME: CONTACT PHONE: apt. . �S� . 9 <br /> c 9►Q,4tAu 6(�K-trt vtr4' <br /> ,,K.- - _\ CONTACT EMAIL: )c*(4)-() b Ia l , �`Y \ <br /> AGREEMENT I hereby certify that I have read and examined this application and know the same to be true true and 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 /> wor which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> wor <br /> F <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,� 1.( I10l <br /> Owner 9 Lathe ze.'Agent Signature Date (Revised 10/30/2018) Page 1 of 3 <br />