1902 112TH ST SW 2019-09-19 - Laserfiche WebLink

IIEECTRICAL PERMIT APPLI Au; ;TION 477CITY 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: °l O 2- l I Z'rn U Je r t-1 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT j REMODEL BUILDING USE: -c SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ iOO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: C,C) rfjztiOY Ov Vorneovv �(/1�1rt ( EIE6I2 — t4� ) 1 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO ❑YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ 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: n NO 171 YES--See Below&Pg.2 nI I 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 LICENSUREZNO 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. :;. CONT CTI OR ATOON ' OWNER NAME: -Um TVyrl7I TENANTBUSINESSNAME(If Commercial): OWNER MAILING ADDRESS: STREET `I�OZ l�Z J+ SIA1 1/��t *=h /-4 , I STATE ✓ N A ZIPcic6ZO4 �y OWNER PHONE: —L20• '✓0��I• =h /-4 yOWNER EMAIL: Ir\ CONTRACTOR NAME: Vl CONTRACTOR ADDRESS: STREET (G270 I ri-AVA. Dy-- GO CIY 51-- /V-w ✓ STATE 0A ZIP (b y CONTRACTOR PHONE:42 .-1(QO '1O5 CONTRACTOR EMAIL: 06 11-6 C- 1 VV\C t . GOv-YI CONTRACTOR LIC.#(REQUIRED): 1 N1(-1-014E 5 q 2_. Gr CITY OF EVERETT BUSINESS LIC.#(REQUIRED): I0 --1-L1J LQ Q PRIMARY CONTACT: -OWNER . ICONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4.2 Cj .7,1 5 CONTACT EMAIL: f ke Km i-r-S @ optooti(, CO AGREEMENT:I hereby certify that 1 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 will be completed whether spec' ed h-rein 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 regul. ng construction or thepe orma e of construction. That I am authorized by the owner of this properly to perform the work for which application is made and I c. .•ly with e State Contractors/ La 27 R'W and 296.200 WAC. City of Everett Official Use Only/. PERMIT#: E 101 2- Own- •uthori •d Agent gnature --Date (Revised 1/11/2019) Page 1-Application