811 W CASINO RD 2020-01-22 - Laserfiche WebLink

Nom tLECTRICAL PERMIT APPLICA LION C1 TY 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: 811 W Casino Rd Unit G BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ®TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ® DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ +` j ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Electrical for New Mini Split system 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? El NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio El Secure Access ❑ 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 IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑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. EYES YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑ E NO YES-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: Bible Baptist Church TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET PO Box 4327 Everett STATE WA ZIP 98203 OWNER PHONE: pOWNER EMAIL: CONTRACTOR NAME: 0 Lj/' / CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ®OWNER ❑CONTRACTOR ®OTHER(Please Specify)Owner/Tenant CONTACT NAME: CONTACT PHONE:425 870 2272 Erik Sanders CONTACT EMAIL: pastorerik@everettbbc.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 an '6.200 WAC. City of Everett Official Use Only PERMIT#: E Dq - \ Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application