10015 HOLLY DR 2019-09-23 - Laserfiche WebLink

ELECTRICAL &MIT & FIRE ALARM PLMIT APPLICATION CITY OF EVERETT PERMIT SERVICES /1111111i1.170‘r-/----A 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10115 Holly Drive PROJECT TYPE:nNEW CONSTRUCTION 0 ADDITION ❑1TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑'SFR 13 TOWNHOUSE 0 .UPLEXDU ❑'MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$1000 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? tirt • 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? F 0 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: REPAIR WRING TO TRASH COMPACTOR THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: flBy 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: pmI Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without _I 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: OLLIN FIELDS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10115 HOLLY DRIVE or( EVERETT STATE WA ZIP 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: EYLANDER SALES & SERVICE CONTRACTOR ADDRESS: STREET 3601 EVERETT AVE CITYEVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016363 PRIMARY CONTACT: JDWNER IONTRACTOR ❑❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425.231.2275 JOHN DA TSHCMCTR EYL CONTACT EMAIL: AGREEMENT:I hereby certify that/have read and examined this application and know the same to be tnie and correct. All provisions of 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only /�/ PERMIT# 0 -i!Authorized Agent Signature Dat- (Revised 10/30/2018) PPS