1123 RUCKER AVE 2019-09-24 - Laserfiche WebLink

S NENE mei ELECTRICAL PERMIT APPLIC A\TIO E 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 I www.everettwa.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 0 3-`-' c BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION LJ TENANT IMPROVMENT [1,1 REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL APPLICATION INFORMATION.& DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: V c —ctken c I > A-A eu h 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 El 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: ❑ NO El 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: ENO 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. CONTACT INFORMATION' OWNER NAME: i � � .� \ TENANT-� BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET � � TZ,-,-lt_ At (7�, J CITY If/�.t,�e_ STATE 1/(. — ZIP of&,y�" OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Cr ,r) 3c-1 S P &f vt C CONTRACTOR ADDRESS: STREET `-ta- \ � STATE (A. ZIP, CONTRACTOR PHONE: 10-3–= 353-573 (CONTRACTOR EMAIL: f d tc' r) `0 1--;.tom ` C(— fit CONTRACTOR LIC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): ( � PRIMARY CONTACT: [JtWNER ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: `J — 9:3 B TT 3 • R f. ,. CONTACT EMAIL: gu:e Str\ /uc__: i`gib' AGREEM NT:I hereby certify that I 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 compl-ted 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 constr,ction or th 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 •a- '. actors La 18.27 RCW and 296.200 WAC. City of Everett Official Use Only ............ ( PERMIT#: 4 �5 � E ►g05 201 OWnerlAu orized Agen ignat e Date (Revised 1/11/2019) Page 1-Application