2619 CEDAR ST 2019-10-31 - 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 425-257-8857 l(E)everetteps@everettwa.gov wow.everettwa.govlpermils ,-ari aotwt* oeg ge i siti ogpV ? a ti i�E3 .iwl 11 PROJECT ADDRESS Zpq Cc^ � , ,BVILDING AREA: sq ft PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ®COMMERCIAL tir m, ,,,;„ZILF xVgAr Cepj.M,I M INFORMATION r DESPRIpTtoNAF WORK{ F 't t t F `; CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: k%Rt kT `‘jCIAA C6 LGjQ '` ' ( - fp THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑YES-Select Scope:❑Service El Feeder 0 Clrcults-#: ❑Complete Re-wire LOW VOLTAGE WORK? Cl NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data 0 Intercom 0 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): ..a CODEF,COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO Li 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: ONO OYES-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 IN,FORMATION•;, • OWNER NAME:CAS a LLQ all/14 ctintKiS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET f�(0 1/ I U Yv`Oh L l d aficl 0-i 4 q- j (/�� /� CRY fi Y & STATE� n(:)(--/� ZIP f �7 OWNER PHONE: O ( )(p I !OWNER EMAIL: a� ` acts cade A t t aC& i t• corm CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CRY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): , PRIMARY CONTACT: tOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ��q �f/� CONTACT PHONE: !,��,rirjt1 XD AlinA/ S 1 vt ( I CONTACT EMAIL: h/f cmu AGREEMENT.I hereby certifythat t have read and examined this application and know the same be true and 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 esume 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 t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: cY)/1,e/i - ET I E lat Oq- b1 O erriA nt Signature Date (Revised g ( sed 1/ JfP20f9) Page 1-Application