804 LOCUST ST 2019-11-06 - Laserfiche WebLink

0,5- ELECTRICAL PERMIT I PERMIT PPLI TI CITY OF EVERETT PERMIT SERVICES -111W13200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECTySITE INF RMAT[OI+f�� , 4, PROJECT ADDRESS:VX1A LTA J PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE G"DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: i�' 0 COMMERCIAL BUILDING AREA: sq ft O EI;E`CTRIGAL`,A.FPLICATION INFORMATION 5 CONTRACT PRICE OF WORK:$ GOO ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑.NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 0 NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRI�T�O OF WORK 8�CObE COMRLIANCE • DESCRIPTION OF WORK: SAIL Dotfyqrra .1. /1Le 411W i•Wvv < t 000 THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑ 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME:lie-WU< TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET t' • CITY iF//�ZSTATE (y ZIP / 9 0'1 OWNEWFIHUN-ETW2ThiLl 914 OWNER EMAIL: V CONTRACTOR NAME:A,. -O' Gt 0 M— i -t�C fi 2J CONTRACTORADDRESS:ADDRESS: STREET 015921 1 1 /WE &E CITY SS/Kien". STATE W A ZIP 12_ CONTRACTOR PHONE:142-7"-' )}�O O tP CONTRACTOR EMAIL:AVM j j '1 E(AA 7 t/l.C) CONTRACTOR UC.#(REQUIREDAUFLA, ()EV V-t,Q CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 09A9j14 PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT It K-NAME: �J k�Z CONTACT PHONE: 4--M-4--M-�1—') r OI �( //�t 1� f •'J\ CONTACT EMAIL: wavy (i A nE f/�/�SThM•( M AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming 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# ci9e4A. 111 E °S OwnerP uthorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3