10315 19TH AVE SE BASE FILE 2019-11-15

ELECTRICAL F LIMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 0477(P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10 3 j 5 19 t o V E. 5 E UNIT 10 9 PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION .94-TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION - CONTRACT PRICE OF WORK:$ f 5019. 00 ASSOCIATED BUILDING PERMIT#(if applicable): 5 I qo l -0)3 IS THIS LOW VOLTAGE WORK? pi NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? g NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: ' R N C M c ( R, cu I T s Po fZ N& Vv g 4-TH R t O M Ni) vrr L 1Tr CLosEr 0 jofl-( H b7- wfi-TEIZ TANK. IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: la NO 0 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:gNO DYES-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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: r1 5 H A 0 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET o3 15 11 -Eh AVE, SE QTY e V& E TT STATE W A OWNER PHONE: (20(7) 'S3- 6 918 OWNER EMAIL: CONTRACTOR NAME: T f{ (Z t ANT ELECTRIC LLC '`: C 0-.S$G, 15t1-C CONTRACTOR ADDRESS: STREET g/! y 7 R s H W o R T H AVE, N, CITY S Ca A TT LE STATE \/ IF ZIP 98 1 03 CONTRACTOR PHONE:(206) 7(°I -40g2 CONTRACTOR EMAIL: IL.EY/TARRANT@ GM AIL. GQ(il CONTRACTOR LIC.#(REQUIRED): TA RR rl e L cr 1 313 W CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0.610/01):1A./ PRIMARY CONTACT: ❑ OWNER A CONTRACTOR ❑ OTHER(Please Specify) Y A) CONTACT NAME: CONTACT PHONE: b2 O f?) 7 19 y O"i 2 L£W TR RRA NT CONTACT EMAIL: LEWTARRftmTGMAIL . CoM AGREEMENT.I hereby certify that 1 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 1 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 WAG. City of Everett Official Use Only PERMIT# ft.fAt).0' 74", T I/24M Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application