3209 ROCKEFELLER AVE 2020-01-30 - Laserfiche WebLink

MNIis ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: • Gf1� p �.'L /t C = BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION Et-TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLdI,C, ATION"INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ `5D©. ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: "T,t c e_t,m r`7.4 ( tf>W Lrr � C� l�� J --;p_ 670 < Cr � (/` /ter THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? E-NO El YES-Select Scope: LI Service El Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO E"YES-#of Devices: SELECT SCOPE(REQUIRED): ❑D to El Intercom ❑Thermostat ❑Audio ❑ Secure Access El Security System El 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: ❑NO ❑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: ENO 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: .r,.�,x / 16/1.c ) TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 32r}q . •C4Jet/i1 4 r CITY �''e STATE LJ.,ort ZIP Ti12-6( OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Se,cc.Cts AA. C(;- J/ , " C'_ CONTRACTOR ADDRESS: STREET )/1J l)y C4tie cm' �� '' STATE `/i ZIP VC/ CONTRACTOR PHONE: A.42.,5-3i-7249 CONTRACTOR EMAIL: (_49(--(c(,, ( (�� C [ C�64,1 I ( LLA CONTRACTOR LIC.#(REQUIRED) `f yq()( CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER P ONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ii.15 Cog— 6.38 CONTACT EMAIL: '1("r C , �"�_ C t.1 r ( AGREEMENT:I hereby Eertify that I have read and examined this application and know the same to�e true and correct. All provisions of laws 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 � l7. PERMIT#: E \01 2,1, Owner/Authorized Agent Signature Date (Revised 1/11/2019) /Page 1-Applica to ( J ;