3003 W CASINO RD BLDG 40-33 2019-09-04

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3 003 vv. c„es,,50.40 �D . �C. -Jlz5 Q. /112.BUILDING igE-A` 4O--33 sq ft PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION gieTENANT IMPROVMENT El REMODEL BUILDING USE: El SFR El TOWNHOUSE ❑DUPLEX El ADU El MULTi-FAMILY-#OF UNITS: EKOMMERCIAL r ELECTRICAL APPLICATION INFORMATION &'DESCRiPTION OF.WORK - -_ CONTRACT PRICE OF WORK:$ Vi, goo ASSOCIATED BUILDING PERMiTI#(if applicable): I I DESCRIBE SCOPE OF WORK: hs�-allll (2) 30A/4 Ov �i>rct��il4 �vQ aK�ti's, Go✓t4LtiT zt Wire,/ QInq (2-) 3o /•neo V vtcr)---tAsecd . 691 3zq210 THIS INSTALLATION INCLUDES TIT/FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LiNE VOLTAGE WORK? NO El YES-Select Scope: El Service ❑ FeederCircuits-#: El Complete Re-wire LOW VOLTAGE WORK? IIQNO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom El Thermostat ❑Audio ❑Secure Access El Security System El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑ Other(List All): CODE COMPLIANCE —IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO ID YES See Below&Pg.2 f! By checking this box,I am stating that I have read and understand all of WAC 296-468-900,selected the specific reason on page 2 l of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. r-� ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: O DYES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and see Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: -1-1-kE- 5oe1t.1G C..OMPAMs l TENANT BUSINESS NAME(If Commercial): 1310kt.da. OWNER MAILING ADDRESS: STREET 'Pp pr�CY..•,3`IO1 �t cry STATE�� STATE WA ZIP G S 124- OWNER PHONE: 2oC,. (a55 . 2-121 OWNER EMAIL: O CONTRACTOR NAME: S--QUOVAI-k ELEG-1 21 C (-LC- CONTRACTOR ADDRESS: STREET �S JS tel- !21.tt Sir err'? t>MCND STATE WA ZIP �O52 CONTRACTOR PHONE:4z5. 61-4-. (Oona CONTRACTOR EMAIL: q •1a�1ce r,ger @ setiLQt C*Ji•e.ov►-i CONTRACTOR LIC.#(REQUIRED): SEQ4171 S9 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 9-0645 PRIMARY CONTACT: DOWNER LfC:ONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 42.6 „zzq,2515 5 JtM Amu/ MAN CONTACT EMAIL: j jrn,Gl•nAe r sc,y) � Liot,l .C.OYYI AGREEMENT:f hereby certify that I have read and examined this application and know the same to be true and correct All prove�fonss Dt laws and ordinances 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 provisions of any other state or local law regulating construction or the performance of construction. That f am authorized by the owner of this property to perform the work for which application is made and l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: .�.� ,g Ei � o0— ) O Owner/Aut,,jrized Agent :Ignature 4 Date (Revised 1/11/2019) Page 1-Application