3718 W MUKILTEO BLVD 2019-11-06 - Laserfiche WebLink

ELECTRICAL PERMIT APPLIoATION CITY OF EVERETT PERMIT SERVICES ilSigliP 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.govI ,..w.w.everettwa.govtpermits PROJECT SITE INFORMATION / } i PROJECT ADDRESS: 37/ r,; tei7-1.Li ki(-lc-0 77k-/..,d1 BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT 0 REMODEL BUILDING USE: CII SFR [7] TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-4 OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK ') CONTRACT PRICE OF WORK:$ --i-L,'-- :-- ' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Z; ,s,-1 5 ocs„) el'-i/ -{,> Th,-.- C.-{- THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO [AYES-Select Scope:El Service El Feeder A Circuits-#: c,..2 0 Complete Re-wire LOW VOLTAGE WORK? CI NO CI YES-if of Devices: SELECT SCOPE(REQUIRED): El Data CI Intercom 7 Thermostat 171 Audio 0 Secure Access El 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. CI Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 7 NO < I-YES—See Below&Pg.2 --,Niotz--- By checking this box, I am stating that I have read and understand all of WAC 296-468-900,selected he specific reason on page 2 MO 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 -age 2 require Plan Review, ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO YES-See Below&Pg. 3 IYES 71 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings or 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 licensingkertification requirement. CONTACT INFORMATION ' OWNER NAME: „s'1/4:,V 674,---/ett / TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3 7/fre C...4.--" III 4-,k,' (17c,,, 2 /-/ — , ,,,7--t- STATE ("14 ZIP V.-4_C2-'02 cl."1 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): , - PRIMARY CONTACT: OWNER OCONTRACTOR DOTHER(Please Specify) . CONTACT NAME: CONTACT PHONE: 1 L5 34/1-,,i --;Z ce4;)r,(..q _.1 ...,..., ,.., V / r ( C",7‘.-1/1/1.1 CONTACT EMAIL: "") (7; , /0 "2fr<.0-'5424 F .oe,44) -1"-- AGREEMENT:I hereby certify that I have read and examined this application and know the same to be t and correct. AN provisions of laws and ordinances governing this type of work moll 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'I&27 ROW and 296.200 WAC. City of Everett Official Use Only 'PERMIT#: Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Apptication ' \