2620 MAPLE ST 2019-11-06 - Laserfiche WebLink

I 1111111111 in ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits �J}� PROJECT/ SITE INFORMATION PROJECT ADDRESS: 201 ( V `4 4jT BUILDING AREA: sq f PROJECT TYPE: ❑ NEW CONSTRUCTION ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$I ;C,C) ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 6- (',,j'1 L jk ,) a rile i Di er f 1/Uo e'Y t i)t 1 Jew 1C✓'; OLc .400r ou -/e-- . lip qre0 e pzi -1 ° I ---rhp to THIS INSTALLATION INCLUDES THF_FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? L NOg( YES-Select Scope: ❑Service CIFeeder Circuits-#: e ElComplete Re-wire LOW VOLTAGE WORK? ❑-NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑ Security System El 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: 71 NO ❑YES--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-90lb,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: NO EYES-See Below&Pg.3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on t5uildings 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:Lj 1 ,i LA J') (� 1,+ r� TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET( 11114V al/4)0L ,f- cITY �y 1 IP � (a STATE 1/1V/fi ZlV��"""v V ti- J� OWNER PHONE: OWNER EMAIL: M�/� CONTRACTOR NAME: V7.141C.-1/7_ LAD/ \J )/k —'-- CONTRACTOR ADDRESS: STREET ��l) 1 ��Q��n �� , ZIP�� ,�� _� 1 , / (CITY VAN( L`,� 1 �t b f�� STATE \ V V1/ ( h C J CONTRACTOR PHONE: +'1I j� U • "1 V ONTRACTOR EMAIL: )3 � k2)UC-I.0 l:(OY)/ i r0��°y7' 1111t 1 3 CITY OF EVERETT BUSINESS LIC.#(REQUIREI tb 01 CONTRACTOR LIC.#(REQUIRED): I,. ��(�I.' ��7�L�� C PRIMARY CONTACT: DOWNER CONTRACTOR EOTHER(Please Specify) CONTACT NAME•r CONTACT PHONE: 1_1a`� l 22 r 3Gj Lt k---) )fl s -eot—L0 - -e � CONTACT EMAIL: G 4 e619)1!C-� ton 1 C. GO AGREEMENT:I hereby certify that I have ad and examined this application and know thT same to be true and correct. All provisions of laws and ordinances governing type of work will be c. .leted 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 re. .ing constr. tion 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 i r`Con actors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ' W a to.„ 0°1 r( \c'llA ',..- ,c5wnerlAuthorized Agent Signature / Date 7 (Revised 1/11/2019) Page 1-Application