Laserfiche WebLink
111 <br /> ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT ADDRESS: 2.-41 0 7 L y''o{ Pr BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION 1L TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> � � '9 r' c ,' as :. _ <br /> xim'�s '� Vii' �• . �� t 4�,„,�t �-ae3-a ..��> ���:�'���'c ... �. . :,x�����^�awe. �. �`.a��.,�. �:. . ,�vtc� a,:�i� <br /> CONTRACT PRICE OF WORK:$ ea`. 0 d ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: f glarke - <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO El YES-Select Scope:El Service El Feeder El Circuits-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO El YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom El Thermostat El Audio El Secure Access ❑Security System <br /> ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I'4 NO • YES--See Below&Pg.2 <br /> ❑ By checking this box,I am stating that I have read and understand all of WAC 296-46B-900, --lected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ►4 0 •YES-See Below&Pg.3 <br /> I-1 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on b ildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> > �' E... '' z� � ��'� pg �jY � 2�c�w s "lit <br /> � �n:n'��U '•,4. 4j t ��'�� i� , ���.�.�.Fav^.a�^.'r.�m.���.w�n�u��.�`�r�a�a�`� n4`��t��:`� xil .'' <br /> OWNER NAME: ligglei <br /> i/ ,9 r t_ T N' T : SNS s , If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> //�� 2i O 1.-"Ce 19� <br /> ' �y !/� <br /> CITY /- V�Q/� P STATE L / ZIP -t s(Y/ <br /> OWNER PHONE: 12.4 i `7l i 6 D OWNER EMAIL: —� <br /> S, r. <br /> CONTRACTOR NAME: a/c -5'• �r/e. �l��C a ,, / ., ,.�,a,�� ��,�, .� .���,_ �. <br /> CONTRACTOR ADDRESS: STREET 3 !�7 d .4/ <br /> cry S ttid voof ST V-' ZIP f 49 <br /> CONTRACTOR PHONE: t /1--5 7C0 L 0 S ONTRACTORpEMAIL:`llgi_K� � / . � _r_ • �� <br /> CONTRACTOR LIC.#(REQUIRED): C 1 ' ET.I `I / CITY OF EVERETT BUSINESS LIC.#(REQUIRE► . S3 S �6 <br /> PRIMARY CONTACT: /�OWNER ❑CONTRACTOR MOTHER(Please Specify) <br /> CONT WCT NAME: CONTACT PHONE: 77 ,.5-50 <br /> r l '1 <br /> WC-- CONTACT EMAIL: <br /> AGREEMENT:1 hereby certify that!have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> -2e/s' E n otc - 2S <br /> Owner/Authorized Agent Signature \ Date (Revised 1/11/2019) Page 1-Application <br />