3431 HOYT AVE 2019-11-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERE1T FCRMIT SEIbilOtS EVERETT .1200 CEDAR STREET,EVERETT,WA 98201 YVASNINGTON (P)425257-8810 FAX 425451484351 Ill.3 urcifettops§uvemtIvea.gov I www_everettwagoviporrnIN PROJECT SITE INFORMATION PROJECT ADDRESS: 647)I it-ocit rivt, BUILDING AREA: sq ft PROJECT TYPE; El NEW CONSTRUCTION LI ADDITION LI TENANT INIPROVMENT M REMODEL BUILDING USE: 1511 SFR 0 TOWNHOUSE LI DUPLEX r L.JADU Li MULTI-FAMILY #OF UNITS: El COMMERCIAL EL C '' A iq. ORMATIPS4'4-4,1'•41'; CONTRACT PRICE OF WORK; UOD ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: AI4 "Ad vjvia. fuf YCa 60,50142. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY} LINE VOLTAGE WORK? D NO 0 YES-Select Scope:[11 Service El Food. CircJits-#: El Complete Re-wire LOW VOLTAGE WORK? 0 NO YES- of Devices:_ SELECT SCOPE(REWIRED):Ell Data El Intercom Ei Thaimost.t fl Audio El Secure Access El Secwity System El Fire Alarm-Installations under this permit only include electrical wiring rough-In uf the system,An additional Fire Alarm Permit is required for review of devico location and Installation approval. Cl Other(List All): ODA,P,O)VIFVANCE'' • IS THIS PERMIT EDLICA1 ION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 22 NO YES--See Below&Pg.2 1—_ 13y checking am this box,I stating that have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 of tids application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Pia 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURCONO flys-See Below&Pg.3 Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease t ; without tho proper electrical licensing and certification,or exemption.By checking this box,1 am stating that I have completed and sea page.1 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement 00141ACTi1tirOff4W—AnOWP: • OWNER NAME! ettf la.V1 MOOVZ TENANT BUSINESS NAME{It Commercial)! OWNER MAILING ADDRESS: sialaq 'it iltVit ArCIWyl- eVert314- friro tITATE cl OWNER PHONE; AV) • 2.51., !SST) OWNER EMAIL! 'CONTRACTOR NAME: V•VIJ#0 Pliekitra- 14rC etili#2111" CONTRACTOR ADDRESS: smccr Lti 1.7_04" 3+ 63A) 44-1 WY Maori+ I(A Cr, ri A lh Pt am' 61Z0 CONTRACTOR PHONE: 42.-5• 1-3/' If,t CONTRACTOR EMAIL; unlit,gri) it-i4 4'10.10N- I vtWk.cor" CONTRACTOR LIC,#(REQUIREDI: 60,..0e)c1.11 15,1.1 IZI4- CITY OF EVERETT BUSINESS LIC.#IREOUIRERI: V041/5 PRIMARY CONTACT: r1OWNER ICONTRACTOR LIOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: k4t -E- 2. • 15-6,6 r oto 1-400v1 CONTACT EMAIL: 121,1 ,moo t a01-tOI -COM AGREEMENT: hem y witty r hove few 40, tawrincgt this uppfitmosn and icncw the same to he hue and caveat. All pMilleilne of inweethinnther- r?0,0101911 type of work wilt lie korpplered trittother specirkx.4 tr4.1ctil or not. me;wanting of a paw*does nor premne to give atithewity to viniata or r:',811K-fft the pmvisiars6of any Whor auto or 1.90/RV/4431111v most/nil/on or Ow portrxrewwo of consimction. That I am authorized by the MYR&of thIA poverty to pointer the work(Or wit/oh Eipplicatiort is,nada and empty with the State r".nniftfelOr$ I/OW and 206.2611 WAG. City of Everett Ofticiell Use Only PERMIT#: -I • E Owner/AMA lao,Agr.mi SIgnature Dart; (Reprised 111 1/2019) Pagel.ApplIcatlen