Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4.11111P404 .":". 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (Pi 425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov miwv.everettwa.govipemlits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Lill tif) ) .) -Or\ BUILDING AREA: sq ft <br /> PROJECT TYPE: LI NEW CONSTRUCTION al ADDITION El TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: El SFR El TOWNHOUSE El DUPLEX 12IADU MULTI-FAMILY-#OF UNITS 17)COMMERCIAL <br /> ELK • s•pktgAnabtritt*ORNIATION & <br /> CONTRACT PRICE OF WORK:$ 1 5(33.L,t) ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: FN.61-,I,A414,,, 7 V(QA. - -v 7.> <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO 0 YES Select Scope: El Service 0 Feeder gil.Circuits-*/ 0 complete Re-wire <br /> LOW VOLTAGE WORK? NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data El Intercom 0 Thermostat El Audio El Secure Access 0 Security System <br /> Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> D Other(List All): <br /> AK- CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: M NO El YES-See Below&Pg 2 <br /> El By checking this box,I am stating that I have read arid understand all of WAC 296-46B-900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:Ee:INO DYES-See Below&Pg.3 <br /> ri Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buikfings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box,I am stating that I have completed and <br /> see Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement <br /> CONTACT iNFPRMATION <br /> OWNER NAME: \r"6,_1; 6 VfitAf- cyt...,SCATENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: . \--etra-LA \(..0s5 \--"Y\ <br /> cm,la.,\TeNc.O. STATE\Jf"'A ZPCI<S66m), <br /> OWNER PHONE: OWNER EMAIL: <br /> n ; <br /> CONTRACTOR NAME: X <br /> CONTRACTOR ADDRESS: STREET t...CIO vt,r <br /> CITY aftne--).11*Th STATE (11;\ 7.046 Ya33 <br /> CONTRACTOR PHONE: 1 LIPC9V-51CONTRACTOR EMAIL:CLOW „ 1)(0 OArf)(4,. <br /> CONTRACTOR1.10. picr le: OF EVERETT BUSINESS 1.10„,fl(RE9uRW:: S 11 <br /> PRIMARY CONTACT: DOWNER WCONTRACTOR EJOTHER(Please Specify) <br /> CONTACT NAME: ci CONTACT PHONE: %.4 eaf.5- '„;-1`itt-tja-c6 <br /> y\Ca\ ekauk) CONTACT EMAIL:( y 'ef 0 (s),,yy ws‘Q (A '‘4 ; <br /> A6FtEEMENT.'I heteby certify that rhavere5tand examined th)s appbcation and know the same to be true am/correct All provls laand• ,, . as governing this <br /> type of work atP 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 <br /> local taw regulating construction or the perflormance of construction. That I am authorized by the owner of this property to perform the work for which appkation is made and! <br /> comply with the State Contractors Law 16.27 RCW and 298.200 WAG City ot Everett Official Use Only <br /> PERMIT#: <br /> E \ 0- 0000 <br /> wner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />