3342 31ST DR 2019-09-10 - Laserfiche WebLink

ELECTRICAL I RMIT & FIRE ALARM F RMIT APPLICATION CITY OF EVERETT PERMIT SERVICES ' I/P.--1 LV 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATIONn PROJECT ADDRESS: '�7 4-� 'h i c t by ev-ve \\ , Ari 01%2_0d PROJECT TYPE: ❑ NEW CONSTRUCTION —I ADDITION ❑ TENANT IMPROVMENT REMODEL BUILDING USE: -0 SFR ❑ TOWNHOUSE DUPLEX ❑ ADU MULTI-FAMILY-#OF UNITS: I I COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ CbQ ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 41 NO U YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? f NO _ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: VJ 0 A C/A V A/\ IA 0 v( IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ 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: LINO EYES-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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: S-ISI 7) t v 1d fO I)/JI /j�TENANTi�BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2797'" I r/i ;/Y' /�,� �/�� r CITY `e}Z F-+,i� STATE V V� ZIP 1 Q2 Q) OWNER PHONE: r OWNv\ER EMAIL: CONTRACTOR NAME: o V1 A9ez I -C(/ V t C CONTRACTOR ADDRESS: STREET 1 2)D I ("TiD( r t/ CCITY 1 \ C t V rA�/�l,c " STATE V/\ I/ ZIP (MO CONTRACTOR PHONE: �Z ( 0 ) 2-03 CONTRACTOR EMAIL: -I n�/If,7Z/v-vIn 41 a1Em CAA 1 . � CONTRACTOR LIC.#(REQUIRED): I N l o V1 e.S GI62 CITY OF EVERETT BUSINESS LIC:*REQUIRED): 'baA 1 0 "p�V PRIMARY CONTACT: OWNER C NTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: 9 U/ D CONTACT PHONE: I t CONTACT EMAIL: v UI W�/ 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 willlbe completed whether Aoecified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state local law regulating cbnbtruction or the performance of construction. That I am authorized by the owner of this property to perform the work for w i//ch ap)licatior on is'made and 1 comply with ti•Mate Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only N /Z--) PERMIT# : / / I /-7 / t I?) I?)\ 0 \ n2' Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application