2413 56TH ST SW 2019-11-15 - Laserfiche WebLink

L LEC��i �C [� PELT APP LOC�QTDOo�� ':;.. ? CITY OF EVERETT PERMIT SERVICES Alr,,":i`✓, 3200 CEDAR STREET, EVERETT,WA 98201T49Pc✓N7 ------ __.._ •� (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits ---- `_ -�1 _— BUILDING AREA: sq ft 'PROJECT ADDRESS: z. 1-.)---'"-: l�' =' i L (PROJECT TYPE: L-� NEW CONSTRUCTION 0 ADDITION TENANT IMPROVMENT 0 REMODEL BUILDING USE: i SFR D TOWNHOUSE Di DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: © COMMERCIAL 1_._— — ELECTRICAL APP;LIGATEGN ENIFORPAA EOM DEOG ]PTECH4 OF WORK �__ I CONTRACT PRICE OF WORK:$ /l,C)U- aU ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: A oO t J c( F c' Z A L +-' LT- THIS fTHIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? C NO 0 YES-Select Scope: • Service 0 Feeder 0 Circuits-#: I 0 Complete Re-wire LOW VOLTAGE WORK? 1rNO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): Data 0 Intercom 0 Thermostat 0 Audio .0 Secure Access 0 Security System o 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. 0 Other(List All): - CODE CO WLEAkCE 'IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ni NO IS YES See Below&Pg.2 fl 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: 11,NO 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 Liwithout 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,INFORMATt ON i OWNER NAME: '1 I ;t t; A I. I ii rt i. NANT BUSINESS NAME If Commercial): � OWNER MAILING ADDRESS: STREET Z�1.3 C� 5 �j�f' CITY fJ ETr-T STATE ZIP l C. • !j {� OWNER EMAIL: :r L I -A Vl 03 4)t t al(C,-CC>CNt 'OWNER PHONE: _ I 4-7(1-1--ZZ T/ �...__ �,.. .�. CONTRACTOR NAME: f-t \p80 eG ,p��- .-- gyp- rc' CONTRACTOR ADDRESS: STREET Fir) �/6C�./'i( 5v 0 ZIP [�" "/ CITY / eekt- ` STATE zcb +CONTRACTOR PHONE: - 9-Zq -$z,-76 CONTRACTOR EMAIL: CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0 6-7\�Z CONTRACTOR LIC.#(REQUIRED):+-nty1l� � Lai � .. . _ (PRIMARY CONTACT: ❑OWNER FA CONTRACTOR 0 OTHER(Please Specify) / (CONTACT NAME: CONTACT PHONE: L 0 24({ v Z'`7 6 V l L.,----- i,�_,, CONTACT EMAIL: S " ' LA—C.1 ` )'+ 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 lam authorized by the owner of this property to perform the work ty for Ewhictt Oh pic licaatil n Use made e and I comply wit he State Contractors w 18.27 RCW and 296.200 WAC. Ci!PERMIT#: t O r E \ OS J OwnefYAuthorized Agent Signature Date (Revised 1111/2019) Page 1-Application