3003 W CASINO RD BLDG 40-871 2020-01-22

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE`'INFORMATIION PROJECT ADDRESS: 3 oc W 0_►,4 S nt.G ��t�c� IC Lf U— 7I BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT IS3 REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL,APPLICATION;INFORMATION +& DESCRIPTION,OF`NORK CONTRACT PRICE OF WORK:$ 70, �jG o, o p ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ? AAefi la-4, s , t t �.0-f- � s c. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? FA NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO P YES-#of Devices:J.,.5 S 114 4 70 SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat ❑Audio El 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: 171-NO LJ 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: 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 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: „�, ti TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7.D, 7 c'7 /'Y)S I t'i q CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: {-v YU CONTRACTOR ADDRESS: STREET 76/ C.1 ! AA/-e S t'a-'' CITY-e.e., t STATE (,(/ ZIP 9 6-7 CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC #(REQUIRED): c_ ( CITY OF EVERETT BUSINESS LIC.#(REQUIRED) (j yy.S'(/q 4 PRIMARY CONTACT: DOWNER ❑CONTRACTOR C4THER(Please Specify) . -''tit ,'./ dtill7— CONTACT NAME: CONTACT PHONE: ac _ 74/3 a yy,y Wjlf r /hi �fry- d CONTACT EMAIL: bLi u/I h Q q 10Gc..�,„i eT AGR MENT.:I hereby certify that I have read and examined this application and know the same be true and correct. All provision f la s 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#: . �� 4/ it 7)9 . E �' l- )1(1, O /Authorized Agent Signature / DaCe (Revised 1/11/2019) Page 1-Application.