8528 10TH AVE SE 2019-09-17 - Laserfiche WebLink

ir ELECTRICAL EMIT & FIRE ALARM PLMIT APPLICATION 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: `fir)9 l"' \\\ 4114....... — PROJECT TYPE: 0 NEW • STRUCTION 0 ADDITION ENANT IMPROVMENT 0 REMODEL BUILDING USE: 7 FR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL. BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 0%`W ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? -C N YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLI , CE • 1 DESCRIPTION OF WORK: 9////-kluQZ, 1).VS-V�,A(SQ„� O KI U{ ) • 4./ NN.V6•CP1 IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 0 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 su ctions 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 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: ) bt \01\e TE ANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET S, ION `j y� CITY + TATE Vdif.)- ZIP � �2 OWNER PHONE:l la c p�83' '6 1 OWNER EMAIL: LGL`i. r4 �vik, t r cuj,\_ CONTRACTOR NAME: K "D ' A i c.-- 2_z_C CONTRACTOR ADDRESS: STREET a& m at ///�� 1 _ G<cm ' i _ t STATE L) I ZIP 1.e!( CONTRACTOR PHONE:Ao6-•G t j CONTRACTOR EMAIL: OY\51< E.4 IL._/a, COM6461-ftf-- CONTRACTOR LIC.#(REQUIRED): 40 _ . ..- Z., 371-1 go CITY OF EVERETT BUSINESS LIC.#(REQUIRED):...,62-1 PRIMARY CONTACT: 0 OWNER w,. ONTRACTOR 0 OTHER(Please Specify) �C�' CON CT VE: /Apr ! TACT PHONE: 60C —4-'— / /'/�� _L ()•�J� \ . ,.:t " J." c CONTACT EMAIL: p t'J /ie�"-6.a'/ YcL3Tr ne-\- AGREEMENT::/hereby certify,/ /ha • read and xamined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work.. be co pleted wh: er specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any of is st./•or - al law regul ing construction or the performance of construction. That I am authorized by the owner of this property to perform the work for whic :.p �i ade and I coo ply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only l. A; PERMIT# Ibi I e c2 -0c0 ( i er/ ,�" orized Agen igna re to (Revised 11/5/2018) Page 1-Application