1510 ROCKEFELLER AVE 2019-09-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PRO.JECT';SITE'JN FORMATION PROJECT ADDRESS: /5/0 ��jr ,I ,e fi1{,�,� BUILDING AREA: sq ft PROJECT TYPE: CI NEW CONSTRUCTION LJ ADDITION ❑TENANT IMPROVMENT '.REMODEL BUILDING USE: SFR ❑ TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRtCAL,AP'PLICATI N I lFORMATION 8 DES+CRIPTI ?N f F,;WORIC CONTRACT PRICE OF WORK:$ 1 f�C7® -' ASSOCIATED BUILDING PERMIT#(if applicable): 1 DESCRIBE SCOPE OF WORK: '�'�1�� n ,), `� 'lC° P,� ar.pi 'yV 2 c `4'' THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO . YES-Select Scope: ❑Service ❑ Feeder [,Circuits-#: Y ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑ 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): CQ�3 , iOMPLtJatNC,E'. .., ... . . .� IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: in NO ❑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 sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:.®NO 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. CON`I"ACT INFORMATION OWNER NAME: tJ>�ti _ems TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET S a r-acx"\ 11• .�-- COY NACI Q+ STATE 1�� ZIP 1 d ,Z_C, 1 OWNER PHONE Ya y ?\5O c .1 OWNER EMAIL CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET IOLA.) G4 114,0/.r G��J CITY( l V C—.."7 STATE A) ZIP G c� : CONTRACTOR PHONE ) ��'7 //j CONTRACTOR EMAIL: Sfr•_ f�!, ytilGf�/� CONTRA,,CTOR LC...#(.R,EQUIRED: ) ..Y..., ' � h CITY OF EVERETTBUSINESS USINESSLIC #,.,(RE...QUIRED) �7_5 ,..L_ PRIMARY CONTACT: DOWNER .CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ® - 3.5? 7 P\� 4" CONTACT EMAIL: – — AGREEMENT:I hereby certi I have read and examined this application and know the same to be true&n8 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 l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: • E V1oS - \ 2S Owner/Author' -d Age - na u • ate (Revised 1/11/2019) Page 1-Application