3110 18TH ST 2019-09-18 - Laserfiche WebLink

= ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STRLL I.EVE-RE i L wa 98201 f P)425-257-8510 I FAX 425-257-M57 1(L)iivolattapsgaverettwa.gov I Movi.everetlwa:gov,pe fir itS LIANIAING I CM pRoJEtrf'tITE INFORMAtION "' ''' — PROJECT ADORESS UO t co 4" bi- BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION 0 TENANT IMEROVNIF,NIT el'REMODEL _ .. BUILDING USE: .V.1 SFR 0 TOWNHOUSE 11 DUPLEX El ADU 0 MULTI-FAMILY-4 OF UNITS:, 17 COMMERCIAL , '---"------ ' Et*P-T,1 „ 1.APP0.10ATION,INIFORMATIOtt& PE& .. . „., CONTRACT PRICE OF WORK:$ti 00 ASSOCIATED BUILDING PERMIT A(li applicable): DESCRIBE SCOPE OF WORK: IY1StA41 ftl,Q,,,) 1_00 CAM# eit:Lintt VA 1,6cikvavi ("MO tweJ Nonrnirl tillit AM co3triT*1 fbe 614 p0a41, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO r: YES-Seloct Scope:le2 Service 0 Feeder CI Circults-,#: 0 Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REOUIRED)„ 0 Data 11 Intercom El Thermostat El Audio El Secure Access El 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. Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: . NO II YES--See Below& Pg.2 U By checking this hox, I ern staling that I have read and understand ail of WAC 29646B-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 Sct.:Po 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 1NO OYES-See Below&Pg,.3 Li Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or loose without the proper electrical licensing and certification,or exemption. By checking this box.I am staling that I have completed and sc.,a Raga.3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this liconsingicartification requirement. CONTACT iistOft.mAilptv OWNER NAME: 411 4-1-cr1 TENANT BUSINESS NAME(If Commercial): 1 OWNER MAILING ADDRESS: STREET bit 0 I tilft St Gil Y6'M-it .3TATT: 44411 ?I.-.leao. OWNER PHONE: lOWNER EMAIL! CONTRACTOR NAME: Blot rvuent, Hroo--11 billr CONTRACTOR ADDRESS: c'-R717- 1 Val 2-1P" R'., 40) 41 crrr 11/440.01/11-1.4(-1 reirrACt !-;1 -F. tic3A ar 61b01,15 CONTRACTOR PHONE:4'0,-)11•11.41"1 CONTRACTOR EMAIL; MINI, dal MIX f4eltrri2 eart-cit'vl CONTRACTOR LIC,#REOUIRED):ftweic-Pei g 2„1 Cie- CITY OF EVERETT BUSINESS LW.#IREOUIRED): i9oLi72„5 „ PRIMARY CONTACT: LIOWNER CONTRACTOR ['OTHER(Please Specify) ----- CONTACT NAME: CONTACT PHONE: 4,11S. 111- 11 a,1 rsfAA0 CONTACT EMAIL: tielpt(- „ ei coiAriforf- com AGREEMENT:I hereby certify that I have read and extimined Chia application am!know tr-e.Same to be kat)end 6-otruct, AY pftWiSiCifIS of laws and urchnancas go varrung,th,s type of vaw*MU he-comokted whether spedliou,hurutta or hut. rho grafthrtg of a pariah does int presume to give aiiiitioiity to violate Or cancel the oroviskAos of any other slate CW ?coal low rogaroiling oanaroorina ort/re peer-km-mace of comtruction. That t am autho,rized Oy/be owout of This property toperfam the work for which app/ice/ion is made cod I comply with tha Sfste Contmacirs law lb 2/Ntlitt OW 2EJ6.2r.i0 WAG. City et Evofett Official the Only PERMITP: ___...._ 1.'Ct5'161 . E t.'' --O OwriorfAuthorized fit Signature nate. (Rat4Sed V/172019) Page 1-Applicarion