5615 SOUND AVE 2019-09-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLIOAilON OIlY OF LVLRETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98701 wASKIRGTON (11)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettma.gov wAror.everettvra.govIdermrtt, , PROJECT SITE INFO- ATION PROJECT ADDRESS: 5 L9I5 swild hJL BUILDING AREA: .;-(1 ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION IA TENANT IMPROVMENT El REMODEL BUILDING USE: C4 SFR EI TOWN HOUSE El DUPLEX El ADO 0 MULTI-FAMILY-#OF UNITS:. El COMMERCIAL 1CAL AP P CATI ON IN FORMAT1P, IJ I CONTRACT PRICE OF WORK: aDD ASSOCIATED BUILDING PERMIT# if applicable): H P4 O - I hut DESCRIBE SCOPE OE WORK: ftviStitik.I no't 4,4+V-4. (old .r.,ind -FVeilt4C4 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO El YES.-Select Scope:El Service CI Feeder Crcuits4J , El Complete Re-wirc LOW VOLTAGE WORK? 0 NO fa'YES-#of Devices:i SELECT SCOPE(REQUIRED): El Data 0 Intercom 191 Thermostat 0 Audio 0 Secure Access [71 Security System 17:1 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. EI Other)List All) CODE COMPLIANCE . ., IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: I YES See Below&Pg. 2 fl By checking this box, I am stating that I have read and understand all of WAG 296-468-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all or 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:KNO OYES-See Below&Pg.3 I I Pursuant to ROW .19.28.261,property owners end 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 pege 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. " . kr''4.0 r•Z• - • CONTASjJ. OWNER NAME:Slava. Mt alet,.,takm etc:t TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET $tit$ sounot PNL env eVext-l-t STATE iw9 b, OWNER PHONE:LW'14•t.101-1 OWNER EMAIL:641\./c .. rtittkloU SY..i imbue c Lv e af-occis, CONTRACTOR NAME: 13a4r1k.ntichutil filv. CONTRACTOR ADDRESS: STREET 11.1.4 110" St S '141 t:av Houvrt 1,41k. 1orra-c-4... STATE 1.4)&) zirA6043 CONTRACTOR PHONE: 145.1'i 1I"!1(34 CONTRACTOR EMAIL: oifo(.0 owe F cA3 IVA ft)rt•con-1 CONTRACTOR LIC.#(RECIUIRLD): Rst.DEPPI-V62-$ Itz-M CITY OF EVERETT BUSINESS LIC.#(REQUIRED}: oq . - PRIMARY CONTACT: ;• IOW NER 000NTRACTOR []OTHER(Please Specify)— CONTACT NAME: CONTACT PHONE: tot*. tidt MIL*NUOINSic-4 CONTACT EMAIL:8.10Ap0le..4131 4untor(oWisezt.rvod5,c.,00rt AGREEMENT:I hambli cadiftt that 1 have Mad AO examined this apptication end know the same to be Imo and tmx-rect AIIpmkea of lows and ordinances governing this re of work WO do oorttooted iemorspotoiriod heroin or not. The granting of a permit does not preattme to On elehouly 10 vloloto COrred tile ptoWASOS of oily erbor 41610 Of meal taw regulating roostructIon or!he performance of coast/verb:1o, Thor I ant outbdti4t1d by MP owner of Ma Awed},to pork-Ian Me,work for witinix apphrieenn inmade comply with roo Stoto Contractors Law 18.27 risw and 2£16.200 WAC. Car of Everett Official Use Only PERMIT II: E Owner/Autha44gent Signature Date (novieott If 1/20111) Page'I-Application