5016 SEAVIEW WAY 2019-09-24 - Laserfiche WebLink

Jan 30 19 02:38p 2065272652 III/.065272652 p.1 4E77ELECTRICAL PERMIT APPLATION ,---- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 96201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@evereUwa.gov 1 vwvw.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ^;( t(e lt tJ t`'2_`ti 1.0 Cu/ BUILDING AREA: sq ft PROJECT TYPE: El NEVI CONSTRUCT1ON ElADDITION alli NANT IMPROVMENT ❑ REMODEL BUILDING USE: L3''SFR ❑ TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNiTS: ❑COMMERCIAL ELECTRICAL-APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ---1--V‘rA,eic.-e_ ‘ ,/vict i THIS INSTALLATION INCLUDES THE FOLLOWING-SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 11J YES-Select Scope:❑ Service ❑ Feeder ❑ Circuits-#: , Q Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El intercom ❑Thermostat El 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 AII):, , • CODE COMPLIANCE . .. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ErNO ❑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 19.25.261,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. .CONTACTINFORMATION . OWNER NAME: PAOl k jledi\Q( TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: STREET , ,(nVt��J �el CITY , If-- �' STATE 4 i ZIP 1 ez' OWNER PHONE: tl� DTy' c�S25V OWNER EMAIL: a c `:I�slip*, evr / ,(� r `. j ( ,�1' CONTRACTOR NAME: /kOIiWY CONTRACTOR ADDRESS: STREET ,(-^ jIt E l CITY cam `-' 0 /STATE UJ A zip/ i CONTRACTOR PHONE: CONTRACTOR EMAIL: 011 . i� G �� >Ct -j�� h CONTRACTOR LIC.#(REQL4RED): p51.3'SK -Z. .27-Ivo CITY OF EVERETT BUSINESS LIC.#(REQUIRED) "I,�,i,,,,�;`- - PRIMARY CONTACT: ,.-L'JOWNER ❑CONTRACTOR . ['OTHER(Please Specify) , -.4•(--1 :2-4- CONTACT NAME:;-{ Lex\c‘ CONTACT PHONE: L4� � .�— �'/ ' `Ckk-,, t,t,j1r„�, CONTACT EMAIL:. 'F'_ „ 'a- v� �n �1 O N AGREEMENT:?hereby certify That i have read and examined tIis application and know the same to be true and correct. Ail provisions of laws and ordinancbs governing this type of work IN 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 t am authorized by the owner of this property to perform the work for which application is made and I comply withrnmiSiate Contractors Law 78.27 RCW and 296.2 90 WA 9 City of EvcrettOffiefal Use only • `t ;.r fp PERMIT#: . / ; :e' a.'1� E 14'6\� Oulfneri46thdri d A nt Signature i Date ( vRe i sediiti/2o1s) Paget-Application