5019 EVERGREEN WAY 2019-09-05 - Laserfiche WebLink

E CTRICAL PERMIT APPLI TION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 5019 Evergreen Way BUILDING AREA: 3000 sq ft PROJECT TYPE: ❑ NEW CONST' " r5N ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR r Ts HOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 7❑ COMMERCIAL RMATON &DES MTCii ` .W# II . CONTRACT PRICE OF WI,=K:$ 3000 ' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF'. ORK: a Led cony of existing xtures THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 17 YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access El Security System ❑ 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): .u4A.N:.. .• -72440DE Q,MPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7❑ NO ❑YES--See Below& Pg. 2 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 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ElNO DYES-See Below& Pg. 3 I I 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 INFORMA"I OWNER NAME: TENANT BUSINESS NAME(If Commercial): BofA OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Apex Electric Inc CONTRACTOR ADDRESS: STREET6830 NE Bothell Way Suite C455 CITY Kenmore STATE WA CONTRACTOR PHONE:206-364-3900 CONTRACTOR EMAIL:nick@apexelectric.com CONTRACTOR LIC.#(REQUIRED):APEXEE1977RT CITY OF EVERETT BUSINESS LIC.#(REQUI D): E 4iT PRIMARY CONTACT: DOWNER •CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-830-0282 Nick Vichas CONTACT EMAIL:nick@apexelectric.com 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 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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Nick Vichas 3/15/19 E \( 03 - � _I Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application