3221 NORTON AVE 2020-01-30 - Laserfiche WebLink

mio 1.10ECTRICAL PERMIT APPLTION 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@Deverettwa.gov( www.everettwa.gov/permits PROJECT ADDRESS: ry�32 -/ f Jv -� E1/4)2.(44-4,-.�jA- !BUILDING AREA: ,?8€f!) sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT REMODEL BUILDING USE: r SFR 0 TOWNHOUSE El DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELEi TION NF 1 ` N. DE PTI OF CONTRACT PRICE OF WORK: � ASSOCIATED BUILDING PERMIT#(if applicable): w- DESCRIBE SCOPE OF WORK: (Zit- j it fik( .', ,nor.;e //1.1/?0!- . - ire_ 0. �,✓ >7 14.1i Vic- .' 1 C cwj-L r r k/ porcril i.JL•LE Z 1..et I1 ito et-)S kinits etwev, #617 0C-4,-(z. tiy4,6 a_plat otikv7(469 rtrzhvt iey THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data 0 Intercom 0 Thermostat 0 Audio El Secure Access 0 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. 471 Other(List AII) it t !I(4> / $ s iez 7�r f t IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ? NO Li YES-See Below&Pg.2 0 By checking this box, I am stating that I have read and understand all of WAC 296-46B •I I,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: ONOfor ES-See Below&Pg.3 El Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings 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: fag. e. '��/p TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2-2../ lubf`iT t Aie- CITY e 1 f�� STATE ZIP 4(2,0/ OWNER PHONE( 2 )..t" _ ')S" .a !OWNER EMAIL: 3 t vory C o 1-j CONTRACTOR NAME: CONTRACTOR ADDRESS: snzeET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR UC.#(REQU)RED): [CITY OF EVERETT BUSINESS UC.#(REQUIRED): PRIMARY CONTACT: / PWNER ❑CONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Cq z,s-j z 3 4,-77i i? CONTACT EMAIL: � ; v i COYY►Ge AGREEMENT:I hereby certify thaf have read and examined this application and know the same to be tro correct Al/provisions of laws and ordinances governing this type of work wiRbe 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 1 am authorized by the owner of this property to perform the work for which application is made and comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /._... E oL a er/Authorized Agent SO Date (Revised 1/11/2019) Page 1-Application