1330 ROCKEFELLER AVE MEDICAL OFFICE BLDG 1ST FLOOR 2019-12-26

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION . PROJECT ADDRESS: 1330 Rocke-letter Ave BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION LI TENANT IMPROVMENT REMODEL BUILDING USE: El SFR CI TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8, DESCRIPTION.OF WORK CONTRACT PRICE OF WORK:$ (LO 000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 44012) teL;cI 5.:-4.;I t j q flevtic ve- 0,-14 a`5 0-AA d ivl rAiki 1-; A; • 31,-10-4,1Q 2,4-LI r cpicte - - .10 - t ow) c_•x- t- .4;-y/I a Re"&„, cL4, Tor kie..44; dco;-9 fele“,lc e4A'64"L L2 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO E YES-Select Scope: El Service E Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom EJ Thermostat El Audio El Secure Access El Security System CI 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: P NO El YES--See Below&Pg.2 r„- By checking this box, I am stating that I have read and understand all of WAC 296-46B-9 I,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: ElNo 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:?1-c,„:at1ckey'1-ev4A ittextie4 I TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 13O t 2 IL 3 4) 44- (i'vi 6 CITY CZt tti/1 STATE co 4- zr, OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: t' E/CCW A— c,-1. reJtviele, 4,J) (— CONTRACTOR ADDRESS: STREET 3(Q11 cirr Seei,141 C. STATE ft ZIP TP,to CONTRACTOR PHONE:Zedio .4 '7.-t' ' CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): VAEEI f52.10Cz CITY OF EVERETT BUSINESS LIC.#(REQUIRED): DOI 5 lir PRIMARY CONTACT: OOWNER DCONTRACTOR EIDTHER(Please Specify) t"-riff 6-(.'...vtt' re1 V7 CONTACT NAME: CONTACT PHONE: '206 --AttStvii 5citittAiti.,;111 CONTACT EMAIL: _AA.%.,4,„1 9 e d 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 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#: 14-/ 41/5_/ii E 10 Ow rlAuthorizi Agent Signatu e Date (Revised 1/11/2019) Page 1-Application