10209 28TH DR SE 2019-11-15 - Laserfiche WebLink

ELECTRICAL PERMIT APPLItPLTION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (4L PROJECT SITE INFORMATION12,-,,...,..... PROJECT ADDRESS: 10209 28th Drive SE BUILDING AREA: NA sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICAT1OKI INF RATJON St DESCRIPTIO OF WORK CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): M1903-048 DESCRIBE SCOPE OF WORK: Gj l '(,�i}/' i -Fly fiA y-'1/A l.L6 1't P IA(,-e,WI 1,1 l' THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ✓❑ Thermostat ❑Audio ❑ Secure Access ❑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: a NO ❑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: ONO 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. ,f ccorrikcir INFORMATION _,. i OWNER NAME: Jose Gamit TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10209 28th Drive SE c,T,, Everett STATE WA Z,P 98208 OWNER PHONE:425 346-6296 OWNER EMAIL:)OSe-gamit jOSe-gamit@comcast.net CONTRACTOR NAME: Always Current Electric CONTRACTOR ADDRESS: sTREET720 N. 10th St suite A403 CITY Renton STATE WA ZIP 98057 CONTRACTOR PHONE:206 793-7920 CONTRACTOR EMAIL:rance@alcuelectric.com CONTRACTOR LIC.#(REQUIRED):ALWAYCE843QB CITY OF EVERETT BUSINESS LIC.#(REQUIRED):056460 PRIMARY CONTACT: ❑OWNER QCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206 793-7920 Rance Pedersen CONTACT EMAIL:rance@alcuelectric.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#: I Rance Pedersen 3/31/2019 E1 VI�U- I- () Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application