2027 HIGHLAND AVE 2019-11-14 - Laserfiche WebLink

• ELECTRICAL PE7tIgiI`T A PPLIeATION . #111/411L-''' CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/Permits PROJECT SITEINFoRMATIOIC PROJECT ADDRESS: ?_t_r? TA-`Th"l)GI\ N._ BUILDING AREA: sq ft PROJECT TYPE: 0 NE NSTRUCTION 0 ADDITION F N NT IMPROVMENT arrVIODEL BUILDING USE: SFR 0 TOWNHOUSE 0 DUPLEX ®ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ r--- —(1A). 0� 'ASSOCIATED BUILDING PERMIT#(if applicable): ric DESCRIBE SCOPE OF WORK: (Nc ; 4 6,PAI,CC C"_ (if, -1-c-4,,,,-) W � , Pug!, '�.Lcs,rW.,j Q 7 -e-k t-,4-,:-, C'-t�-.Vk•7$ "T ifri r 3L l '.?'U-i >�c FuaS a L- e_c THIS INSTALLATION INCLUDES THE FOLLO G SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO YES-Select Scope: I0 Service 0 Feeder 0 Circuits-#: 3 in Complete Re-wire LOW VOLTAGE WORK? Ia NU • YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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: 0 NO 0 YES See Below&Pg.2 1:1 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 OYES-See Below&Pg. 3 El 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,INFORMAIIOhr, OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITYSTATE ZIP OWNER PHONE: OWNER EMAIL: -� CONTRACTOR NAME: Gc � S�..7 r(e_tAv`cc LI C CONTRACTOR ADDRESS: STREET .\ ' Q (DSc 4l 1 l /)�/^� �/" CIN .LA, kI"`"J .. t ` STATE `' ' I ZIP /� CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC #(REQUIRED) �� SSC r 4�r3 "CITY OF EVERETT BUSINESS LIC #(REQUIRED): x'.3.37 PRIMARY CONTACT: 0 OWNER • ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: LF O - S'7' g 0,4 •n I-,- ,d ) CONTACT EMAIL: AD Gcc ci SmSe dcc4v,Z , Co sA-i AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and 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.y he pe rmance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I ! City of Everett Official Use Only comply with the State C ntracto Law 7 RCW and 296.200 WAC. 111) (�-�n� PERMIT##:Mr5--E iW Owner/_ 'zed Agen -'•nature Date (Revised 1/11/2019) Page 1-Application