609 WOOD PL 2019-09-17 - Laserfiche WebLink

ELECTRICAL PERMIT A 'PUIC . TI®N CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 g.tf k(a (P)425-257-8810 I FAX 425-257-8857 425 257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits Wi . ' l EPROJECT S 1gi.fi b ONSLN : _ \ iI 5M La' PROJECT ADDRESS: 6.09 1000.12J � eg 511 (, l f�� (BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU MULTI FAMILY #OF UNITS 0COMMERCIAL VS:gVS! 'Mx.M,ELECTRICAL *PPUC 1T[ NMNFOR ATI`O' 1_ `EE.+ �' MO VNST r CONTRACT PRICE OF WORK:$ /0'0049-12— (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: EiJ✓r+Tofi, l 17/5 ) 7ir i_l'i/T /7/06 KEG yi-e-tES )41-n-nnri 0`.ovouiTs OA)CI THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO PI YES-Select Scope: 0 Service 03 Feeder ®Circuits-#: It 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: ®Security System SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access .®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. 0 OtherList All ,�yy�� *-� s �.._4ti x r�.. i �_._$ 'Other( .� z) `�.sCy�: ^may MP A MIN -, AMI"v s{."is .`a`�� -.j„` i`NV '' , Mai IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO CI 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:,®NO OYES-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. MOMPSIOESSEEMMINTSMOMONEAATIOMMATIPWROMMINSWEEMMONSEM OWNER NAME: 'Korz,4 - 52-1,(7"6" TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET STATE ZIP CITY OWNER PHONE: OWNER EMAIL: -.. - CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET /,2 /l /ma ��/ g�j;�0� carr •Y-V • eXe /y STATE co{K ZIP CONTRACTOR EMAIL: pt-/-ee/ec-f1G j�G'L ' 0044 CONTRACTOR PHONE: 425- ZSZ � I era CONTRACTOR LIC.#(REQUIRED): %3 ! 1917_01 EVERETT BUSINESS LIC.#(REQUIRED): .249..26, PRIMARY CONTACT: 0 OWNER PE CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4-z5 _ 550 Bjf2G/t 7 ICIZ, S CONTACT EMAIL: Ar'cr,-I,+ee-1e -f 1cb(` 9 4iL ' Cow._ AGREEMENT::I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions f 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 City of Everett Official Use Only comply with the State Contractors Law 98.27 RCW and 296.200 WAC. PERMIT#: 5--2 '" E 1\O� _ IC0`-1 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application