2810 LOMBARD AVE 2020-01-30 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT':SERVICES 4,111W.1- 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 J(E)everettops@everettwe.gov I www.everettwa.gov/permits PROJECT ADDRESS: a h GL K`r f11 Z="i'I` i I BUILDING AREA: //poi) sq ft PROJECT TYPE: 0 NEW CONSTRUCTION I. ADDITION [4 TENANT IMPROVMENT D REMODEL =UILDING USE: 0 SFR, El TOWNHOUSE 0 DUPLEX [l ADU 0 MULTI-FAMILY-#OF UNITS: 7...11 COMMERCIAL his 7 .v CONTRACT PRICE OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable):. DESCRIBE SCOPE OF WORK: e/1 64-o, I }G 14 {i fin e 4 1'1 1 ( i 4 •••-y4 v THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? ( ,NO ❑YES-Select Scope:0 Service ❑Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 'YES-#of Devices: _1 SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat ❑Audio 0 Secure Access ', Security System 0 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: !r.4 NO ■ YES See Below&Pg.2 ❑ By checking this box,I am stating that I have read and understand all of WAC 296-46B-980,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I moot 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:gNO DYES-See Below&Pg.3 UPursuant to RCW 19.28.261,property owners andleaseholders 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. OWNER NAME:,J -h,izeleg V) 64r; 4c9 TENANT BUSINESS NAME If Commercial: , •. • OWNER MAILING ADDRESS: STREET 'A I p L 'TJX h rd,y >l— , to 1- .? i 0,-, (/ CRY Ce STATE /A) i ZIP Cilea eJ�v I OWNER PHONE 1 .5 y S V lovvNERENrzy.c"_t4.1,41e., ._ ..� ,.1 _.. M -7 r ..5. ?1' CONTRACTOR NAME: A-10. ,5-0 I IA 7 4e, r l r I� l a ( W CONTRACTOR ADDRESS: srrtEEi 44.,9 f a — j s ~r , A-tt CITY ) -I-ft I. STATE k)r' ZIP :i. i f o CONTRACTOR PHONE: 6 ,-2, 7 -A3'.5 CONTRACTOR EMAIL: "ICL O Gc, CONTRACTOR UC.#(REQUIRED, f,? A r . r CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: [DOWNER NICONTRACTOR DOTHER(Please Specify) j CONTACT NAME: CONTACT PHONE: Z t7 b a f7 i �► oL L 001-71'53 ,414k, CONTACT EMAIL: 131. 4111 ► (`i:' �..°ct0,11„SY3 �L/l� sez� -4� (Ala(1`� CYI� AGI ENT:1 hereby certify that I have read and examined this application and know the same o e true and correct. All provisions and brdstances governing this type of work will be completed whether specified herein or not, The granting of a pennit 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#: 20i' E 10 01-\- (6(6 Owned rized Age Signature Date (Revised:1/11/2019) Page 1-Application