3124 OAKES AVE 2019-11-07 - Laserfiche WebLink

• -i ELECTRICAL PERMIT APPLICWION "IIPIOEI —Ai CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857// 1(E)everetttepp�s�@'ever]ettttwa.go0v www.everettwa.gov/permits z :; 1 -> d� iE Y.l.� \S v. �^'RROJEO�1 o� IWORIVIA 0.O,H?r`s�S hstt�. �,Isji'> �.z yk -n£�i�.'•h�.,..?t.��.. ..E wwa_,... ..,��.°. ?...,�.�.....,_�. .>.z �" n&-,v,eS'�,,.. Tin`� a.,',.s`.... .... ....�'�....,�. ,.>...evereteps@WeveretVtwa.gov ..,.... �l�Y� PROJECT ADDRESS: ''t VaYves /IdV (BUILDING AREA: sq ft PROJECT TYPE: 0 NE STRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI FAMILY #OF UNITS: 0 COMMERCIALS CONTRACT PRICE OF WORK:$ R.(00 0 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: A i � \ t`1 It YotweA Q-eQ'ke-eiv-e\ oul .-- Livetvz THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELTHAT ) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: ECService Feeder 0 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 '0 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): IS THIS yv ��• THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LJ NO YES—See Below&Pg.2 ® 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO ®YES-See Below&Pg.3 ® 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. Vi$ SMSM. ZERSV S1RyIM'*aZCNFPVAKOrhWw nRwb w t OWNER NAME: '''--16A1 (io.rr ` vTENANT BUSINESS M ftCorRmercial): MAILING ADDRESS: STREET 3 1 ei L/%� \`V C/1 OWNER e / k ��4 ,�n',.,�'C SATE ZIP / l! CITY ��"'YYY ////// ` 49 OWNER PHONE- �� -As OWNER EMAIL: \ tip �> CONTRACTOR NAME: albS1--QS-' 7 L. CONTRACTOR ADDRESS: STREET 3.141 ' AL " V, r CITY iall AV 1 I' `- • STATE ZIP / ' )_ eNTRACTOR EMAIL: YiSk^C S E)ec ti ( • 1.'-'' 44 CONTRACTOR PHONE: 01B "C�� " G CONTRACTOR LIC.#(REQUI, D): :!..://7..r.:r7 a CITY OF EVERETT BUSINESS LIC.#(REQUI-WO* q PRIMARY CONTACT /,: TRACTOR 0 OTHER(Please Specify) �� CONTACT E: r CONTACT PHONE: 9069' 6pf.cgs Fp CONTACT EMAIL: , ,hr /`c!e,Ar,L_ ii> �GU6 • P .7fi t - , examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this or t \14- AGREEMENT:workwilll b er=r y t i that I has- ead and A type of work b=cf p to, wheth- 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 local law regu- ; con-ruc ion or e performance of construction. That I am authorized by the owner of this property to perform the work or for r which ctt Official application is Use made and I comply w' �- ate ont,=ct• Law 18.27 RCW and 296.200 WAC. PERMIT#: A / .... � IE lG\ o3 O ` t l Owner/Authorized Agent Signature Dat= (Revised 1/11/2019) Page 1-Application