11704 EVERGREEN WAY 2019-09-06 - Laserfiche WebLink

LLECTRICAL PERMIT APPLIIIATION 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 . S _ MP t jaMSI 1NIFOR `1CL014101' T tiK. AI , PROJECT ADDRESS: i 170(..-1 EV �>n a-�Iltei'L f BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI FAMILY #OF UNITS: COMMERCIAL ELE 1a LCAL ARp,I MO:N 4AORMW VCOE'!CR„'.1),P tlPLN �1 RMTtt u '� '�`+�`�,it}'�..,� 3�'�a G�;�� [.41 c � � ��H�xrx�,�-„eY'��..... M CONTRACT PRICE OF WORK:$ 75-0 f ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: hS� A vt.c-(A) liJe,, ep1(41"til FCS .4-,by ell --4h-;bt)1-A can bad THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 19 10 0 YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? ❑NO EKES-#of Devices: L SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio '0 Secure Access 0 Security System 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire arm Permit is required for re iew of device location and installation approval. Other(List All): ISSAREY 4 OVM S R:ixO,,,,.'P ' 2 AO: PPa.NCgffAG?. +O` ` . ".'•.r'O '"aa y.;k ��'£Fy �' zx*�,„. Wor IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: €" tea0 ®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 OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑Y 0 ES-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. sMyWvWEI & d. Dx . .. A . LATIOWIViCsMNSERIS ' Na. /'p OWNER NAME: C / rO TENANT BUSINESS NAME(If Commercial): ( /,u Ahro✓i OWNER MAILING ADDRESS: STREET VLA, a.-S COODU-Q- CITY STATE ZIP OWNER - OWNER EMAIL: � .. . .< .... __ _ PHONE:L Z �J .;. . ... mg.: _. ,., ., ...m. �.>.. .,, ,. CONTRACTOR NAME: '1 46 SOf CIS-`c' CONTRACTOR ADDRESS: STREET 10(6-1 S i1.--eKca1 _tAje.t # 1��tZ' Q 'l- ZIP 1J i/ I CITY l�-I CONTRACTOR PHONE:23-3-3-7Ze3D CONSTATE TRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): Gt f. L t K CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ex( PRIMARY CONTACT: 0 OWNER ►: CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: e53- (-1 0c- . t 7- Lc. `,- r CONTACT EMAIL: . ,K�� 114 6, _ V-i'LS'v' C()/V? AGREEMENT:I hereby certify that!have read and examined this application and know th.,t.,,,e to oe true anu cureur. HO provisions oNaws 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 lam authorized by the owner of this property to perform the C work of Efor whicht Opic licaati ion Use Only is made and! comply with th r tractors Law 18.2 W and 296.200 WAC. PERMIT#: i "AirI / lO — � -( Date (Revised 1/11/2019) Page 1-Application Owner/:uth:rized A,� Signatu