2424 COLUMBIA AVE 2019-11-01 - Laserfiche WebLink

NEE ELECTRICAL PERMIT APPLICATIII. I EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION 11 PROJECT ADDRESS: 2-tiZy C.`-t�l t�W\+b BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT E REMODEL BUILDING USE: SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: _ ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ \7_15,00 !ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: G�A i \'1Gek•r c CV-Li/ 4-S THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ,�❑ NO �= YES-Select Scope: CI Service 17] Feeder Circuits-#: 7 CI Complete Re-wire LOW VOLTAGE WORK? ` I NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED):777❑ Data CIIntercom ❑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: r NO I. 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: LINO DYES-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: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: NV‘C 4c c �\&t-�-c(� CONTRACTOR ADDRESS: VV STREET 3_ �7' A\J`1� ,^`^`^ �I[, CITY 'r ` J \ \\( STATE WA ZIP 4�Z7O CONTRACTOR PHONE(W1SJ 5 33-676 ( CONTRACTOR EMAIL: •c\ kc ejP-G\--c\L��Yin o.; i CO+`1 CONTRACTOR LIC.#(REQUIRED): PI\ Cc,• 0.6— ic ‘1 K6 CITY OF EVERETT BUSINESS LIC.#(RMUIRED): o(01.363 PRIMARY CONTACT: DOWNER -ONTRACTOR ❑OTHER(Please Specify){ CONTACT NAME: CONTACT PHONE:(�Z,S, S ? - (o 76(„�1 k 5 `n'(\ f CONTACT EMAIL: \t\�I � eke L-C ,t 0 (Y)o\ I%1, l (O\ AGREEMENT:I hereby certify that I have read and examined this application and know the same d be true and correct. All provisibns 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: gyp- g— . 0k6k E �� I — F1(0 Own Autho ed Agent Signature Date (Revised 1/11/2019) irage 1-Application