3417 TULALIP AVE 2019-11-07 - Laserfiche WebLink

mit ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION • PROJECT ADDRESS: -( - -ru I c l j p ��! //j BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT P a REMODEL BUILDING USE: 17,SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL • ELECTRICAL APPLICATION INFORMATION I&„DESCRIPTION:OF WORK CONTRACT PRICE OF WORK:$ 6a) ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (,i 5 op pip C .[ r 7 Y46 V d (! � (' THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? A NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ['NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access ❑ Security System ❑ 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-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: 1O EYES-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. CONTACT INFORMATION OWNER NAME: A 0 e I U 'Sm,1-k TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDR SS: STREET I l 7(� l ct lit 611/be CITY /// STATE ZIP OWNER PHONE: ,C6 7-69 /63 9- OWNER EMAIL: CONTRACTOR NAME: 6 y)e (9'I C eC I r"tc Inc CONTRACTOR ADDRESS: STREET 12371 �i i lti 1/9//' , (r .3 CITY 4'lu.vy 1)L le STATE 1)4 c'�/4 ZIP [e?in/7 CONTRACTOR PHONE: 1 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) ENE.R&r T W j(l( � CITY OF EVERETT BUSINESS LIC.#(REQUIRED)5 L�,7 - PRIMARY CONTACT: NoWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: p,4 CONTACT PHONE: 425 2,3 I 6 C i et S 73 7 (2 2 1 en CONTACT EMAIL: er OW e-1 C- Vr- \(_.�c_l) - yrtt�l 1- Co or) AGREEMENT:I hereby certify that I have read and examined this application and know the same to ble rue and correct. All provisions of laws and/ordinances ld/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 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#: 7- /cI E \,�ock :/ ^ 'Aut".rized Agent Signature Date (Revised 1/11/2019) Page 1-Application