12800 19TH AVE SE 2019-11-15 - Laserfiche WebLink

LLECTRICAL PERMIT APPLitek6kTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX425-257-8857 I(E)everetteps@everettwa.govI www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 12800 19th Ave SE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1,200.00 ASSOCIATED BUILDING PERMIT#(if applicable): B1907-015 DESCRIBE SCOPE OF WORK: Extend existing circuits into new walls to cordon off break area. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#:2 ❑ Complete Re-wire LOW VOLTAGE WORK? NO ❑YES-#of Devices: _ SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio El Secure Access El Security System El 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 CI IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO U 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: Providence TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Dahl Electric, Inc. CONTRACTOR ADDRESS: STREET 3409 McDougall Ave CITY Everett STATE v v`/�/ A ZIP 98201 CONTRACTOR PHONE:425-2552-1700 CONTRACTOR EMAIL:dstevens@dahlelectric.com CONTRACTOR LIC.#(REQUIRED):DAHLEEI926QD CITY OF EVERETT BUSINESS LIC.#(REQUIRED):037-024 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-346-5317 Jeff Allison CONTACT EMAIL:jdallison7@msn.com 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#: O.. Zeit 9-4-19 E 1/33 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application