9300 W MALL DR 2020-01-30 - Laserfiche WebLink

I ELECTRICAL PERMIT APPLICATOR ,� J CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 � ��/ (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT ADDRESS: 94300 W e 51- Me,/ / / BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL ,BUILDING USE: 0 SFR 0 TOWNHOUSE C DUPLEX 0 ADU ,moi, MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL ,Pt ILICA EGL Empor J a 1�'GN .; meaturnotz OF wow( . CONTRACT PRICE OF WORK:$ —](?QASSOCIATED BUILDING PERMIT#(if}applicable): ✓� 1 DESCRIBE SCOPE OF WORK: RP/J r P 3 '02(l dvt.� Si 47 /P_ Inn 1� 't/`ropk,i f GUM 1i J a �:' r.) 'e �.^Q4 Jd 9J f �� e_ / 'tip y�ot' ('ate �/9 i�s. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? D NO 'YES-Select Scope: UI Service U Feeder Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 1❑Secure Access 0 Security System 0 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. 0 Other(List All): CODE COMPLIANCE IIS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: U' NO U,YES See Below&Pg.2 I 0 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. TARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:WO ®YES-See Below&Pg. 3 ii Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease 1 ! 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. OWNER NAME: (.4Je' 7 /Yl a 1 . p QGe TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET /3'oe— West 41.9-c.c. DR- ,t - Qr �,/ CITY G sire'. / STATE ZIP 'OWNER PHONE: 11 3 7 7 O 6 OWNER EMAIL: ......-. _ ,� CONTRACTOR NAME: S/YI t-- 4CleGfieitic_ – � CONTRACTOR ADDRESS: STREET r 2R. O l! ' . 'f"/�, T /J4 �j V1 CITY ctp/x 'C ^ STATE ( ZIP qO/v (CONTRACTOR PHONE:96 6.32_1-a2 D i/D (CONTRACTOR EMAIL:sme me_aacpt le. Coy A CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O C . (CONTRACTOR LIC.#(REQUIRED): 5 N1 e- 1454( D�O p `� PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑OTHER(Please Specify) 1CONTACT NAME: CONTACT PHONE: 0,z06 7/f. 5201 4 `''Y-ie. . c al,v1/1 I IC�I'�Q CONTACT EMAIL:�U4h� �10-SJY1G//I G Q Sr'r? LL�Ntif AGREEMENT:1 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 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 lam authorized by the owner of this property to perform the C r ooEhwhichOR El OTHlER is s Only made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. tyAl PERMIT#: 3 •1W./f -i/ -' 1. (Revised 1/11/2019) Page 1-Application 0 mer/Authorized Age Si. ature Date