3221 NORTON AVE 2020-01-30 - Laserfiche WebLink

Elm ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everettepseeverettwa.gov I vwuw.everettwa.gov/permits ° s x [ ,"' 'P sia: ■ ":t r�j� y 5 t `� k ik z n ,, PROJECT ADDRESS: 3 22 iJc,r 1V BUILDING AREA: 3 F� sq ft PROJECT TYPE: D NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT P7REMODEL BUILDING USE: I SFR ❑TOWNHOUSE ❑DUPLEX CI ADU 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ECTR#C 'PtIC T WOW: ,,&,` .SCRIPTION Ol O CONTRACT PRICE OF WORK:$ Z7b a ,70 'ASSOCIATED BUILDING PERMIT#(if applicable):g / Q DESCRIBE SCOPE OF WORK:/4z re f^ f r1.Oi-- (,,o ff e t F) n,� ens. T� 14'J / )tth CsDi?e./ - THIS INSTALLATION INCLUDES THE FOLLOWING SCOPAL °THAT"APPLY) UNE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service ❑ Feeder El Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 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. 171 Other(List All): �JA,G, 4 kigivk ' t y a n:i � PE a ft ^' atg - ti, a ;z,! 1S THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [ IVO t]YES—See Below&Pg.2 0 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: ONO 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/ac application to receiveanexemption from this licensing/certification requirement. sONTACT„INFORMAT .a OWNER NAME: J(2,yyvp,s f..., T UL' / TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3 Z-2../ tJ 477Y1 AVZ- CITY E1l .44- STATE 14' ZIP, 1.v/ L, OWNER PHONIC: Z4)2�7 f fj� OWNER EMAIL L!�/`�7 C ,�y�G,�c!>� ' yi,B4 CONTRACTOR NAME: / CONTRACTOR ADDRESS: STREET COY STATE ZIP CONTRACTOR PHONE: _CONTRACTOR EMAIL: CONTRACTOR UC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: (OWNER ❑CONTRACTOR DOTHER(Please Specify) CO TACT NAME: CONTACT PHONE: (. 2„5-1 j 14„x.- '.p- - ! l� 1 Wl,(/5 E • C(/®r CONTACT EMAIL: - ,e- c� P. VC� 9ivt[�G��r AGREEMENT:I hereby certify that/hav4 read and examined this application and know the''ame to be true correct Al provisions of laws and ordinances governing this type of work wilt be completed whether specified herein or not. The granting of a permit does not presume tp give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That lam 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#. �. (2_,/0//i E V9 2. OL( 7mer/Authorized Agent Signa Date (Revised 1/11/2019) Page 1-Application