1832 HOYT AVE 2019-09-23 - Laserfiche WebLink

EMI ELECTRICAL PERMIT APPLICATION C11YOFEVERT I PERMIT SERVICES EVERETT ,3200 CEDAR STREET,EVERETT,WA 921 (P)42:5-2S7-8810 I FAX L25-257-8657 I(E)murottopsUovurettvre.gov voinor.evetettwa,g,nwpermits WASNiNOTON PROJECT SITE INFORMATION PROJECT ADDRESS: 1lDu)V Ave BUILDING AREA: sq ft PROJECT TYPE; ID NEW CONSTRUCTION U ADDITION Erl TENANT IMPROVMENT LI REMODEL BUILDING USE: SFR 0 TOWNHOUSE EI DUPLEX 0- ADU Li MULTI-FAMILY #OF UNITS:, COMMERCIAL gi*PlAtiMiAPPVC$010* t1FORM4MONADASPAIPTIOPO OF WO:r CONTRACT PRICE OF WORK;$ 1,100 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK; 144 arla4Y1fthr kflaCt 1. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:0 Service El Feeder gi Circuits-ti, I LI Complete Ro.wim LOW VOLTAGE WORK? 4 NO Ell YES-4 of Devices: _ SELECT SCOPE(REQUIRED). El Data 0 Intercom B Thermostat El Aude a Secure Access CI Security System 11 Fire Alarm-Installations under this perrnit only Include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required kw review of device location and installation approval. 0 Other{List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: n NO YES—See Below&Pc.2 LIBy checking this box.I am stating that I hove 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 LICENSURErPNO OYES-Sae Below&Pg.3 L Pursuant to RCW 1928.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sate,or tease without the proper electrical licensing and certification,or exemption.By checking this box,I arc stating that I have completed and see pag(L,3 signed the AFFIDAVIT on page 3 of this application to receive an Oxemption from this licensing/certification requirement. . . iiiAcotLAcTINFORNIATOOW OWNER NAME: Rtyce, WWI -Attn: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sir= I tb,2, CITY' e\Mf-tif STAW V*3t414 zir 514 k OWNER PHONE: LA11,- • 2_2.0 OWNER EMAIL: glAri Stri%Ur 4,04.,V10 0•(11nel CONTRACTOR NAME: e;IUQ III.Mb tt.iii.1 At e CONTRACTOR ADDRESS: EnTiFEr 111 to 2.1.0i+1 St 6A) 44' t-iouvt take reylaik.k.k. STATE (A)er xe CONTRACTOR PHONE;t415-111-11- CONTRACTOR EMAIL: L ro, L1UYtie Yvi CONTRACTOR LIC.#(REQUIRED): 131-1J% tetr. CITY OF EVERETT BUSINESS 11C.#(REQUIRED),: 1.10453,i • , , • • PRIMARY CONTACT: OWNER 000NTRACTOR LOTHER(Please Specify) CONTACT NAME; CONTACT TONE', 2.2.0 /6(61 Rate.. V.W141 6.11,114 iA - CONTACT EMAIL;40yta,stri nom.", aViz 0PIM• AG'REEMENT: hereby certify that ape reed Mid axamfned this aPOCatreo and know the same to he nue Mr1 C6v713Gt- PiriansicknEt we and Ofdia8n4P4 gOverreN this typo of work wiN he completed whether,sp,eCifieff hat&or not The pahrieg of a prima does not prawns ro gros,suthormy to amore or r.aiheet rhe preWskma of any Ohm'Moto or local taw regulating.conatruction or the pato-name of weskit:Um That tarn authorized by the ownar of thrz property re perform the work tor whith typtreOrklq is tnado out I comply with the State Contractors Law 1It2 W anti 254%20,9 WAC, City of Everett Official Use Only PERMIT#: Er\RDS — . )(9 ,rized Agent Signature Date (Rovisorf l/t l/2Otf Page 1-Appileetion