5408 S 3RD AVE 2019-09-17 - Laserfiche WebLink

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 I(E)everetteps@everettwa.gov www.everettwa.govlpermits PROJECT SITE INFORMATION. r PROJECT ADDRESS: •) -5 - BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION .. TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL.APPLICATION,'<IINFORMATION 8;DESCRIPTION OFWORK ' CONTRACT PRICE OF WORK:$ 2__o& CJ- ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 12eye, C'e ,lf'c2 7+' f c't / )he / THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 1O ❑YES-Select Scope: ❑ Service ❑ Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat El Audio ❑Secure Access ❑ 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. El Other(List All): CODE COMPLIANCE IS THIS PER I -DUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: O El 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 t PZ-4° of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not e°-e Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO YES-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: ))7‘76 �l Cc /`j,� �(/' L TENANT BUSINESS NAME(IfCommercial): OWNER MAILING ADDRESS: STREET ./ (3_2 cf i c / (.G L'e- CITY /� CITY (/ e# STATE "j //��{/ ZIP 2496 / OWNER PHONE: OWNER EMAIL: !!! CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(RE. IRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: FA OWNER N❑CONTRACTOR ❑OTHER lease �� FA Specify) CONTAC AME: �— CONTACT PHONE 12i.-)5"0 ( J/ ,/CL/(- to /C(( CONTACT EMAIL: Sbi= ty /y/XC t`', y01,2T7(2/• (Ct) correct. All rovi ns of laws and ordinances governingthis AGREEMENT.'I hereby certify that I have read and examined this application and know the same to be true andp 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 1827',►- and 296.200 WAC. City of Everett Official Use Only PERMIT#: 0 / E - 1 ,6?;, t 'r:/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Applicati`oh�l