5616 WEST DR 2019-11-07 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE;INFORMATION PROJECT ADDRESS: 6(.0 I(p BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL 1C )ZE' AN 2- BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ � ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: jZc p 012.0 x(1() THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO F YES-Select Scope: ❑ Service ,0 Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ 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: 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: ENO 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:-L:-,` ?, v2 c.; TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5‘.,..1(0 CITY it -) I STATE \.A., ZIP `C&Z..0 OWNER PHONE 2'3 47-$ ,,,,c)(7-15 OWNER EMAIL C..'n b)V..j— '�( 1Z (-10rfil4)L CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) CITY OF EVERETT BUSINESS LIC #(REQUIRED) PRIMARY CONTACT: ]OWNER ❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3�,C, 940 ` I CONTACT EMAIL: AGREEMENT:I hereby certify that I have read and examined this application and know a same to be true and correct. All provisions of laws and ordinances governing his type of work will be completed whether specified herein or not. The granting of a permit doe 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#: /o//i / p E��1cO _x`30 0 ner/ uthorized Agent IgnaDate .._ (Revised 1/11/2019) Page 1-Application