Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WALH3NQTON (PY425-257-8810 I FAX 425-257-8857 (E)everetteps©everettwa.gov www,everettwa.govtpemrits <br /> PROJECT ewe INFORMAtION <br /> PROJECT ADDRESS: 3020 Rucker Ave., Everett, WA 98201 BUILDING AREA: NIA ww sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION D TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> ICAL APPLICATION INF , ` ON s:. RI ION,' WORK <br /> CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): N/A <br /> DESCRIBE SCOPE OF WORK: <br /> Disconnect existing rooftop units and reconnect new units once installed. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO J❑YES-Select Scope❑Service ❑ Feeder ✓❑Circuits-#:5 ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices' <br /> SELECT SCOPE(R:EQUIREDI: ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access 0 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 /> 0 Other(List All)- <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: a NO YES See Below&Pg.2 <br /> nBy checking this box,I am stating that I have read and understand all of WAC 296-465-900,selected 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 PlanReview. <br /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO . YES-See Below&Pg.3 <br /> fl Pursuant to RCW 19.28,261,property owners and leaseholders cannot perform electrical work on buildings 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 /> CONTACT INF EATION F-r. .ate <br /> OWNER NAME: Snohomish Health District TENANT BUSINESS NAME If Commercia :Same <br /> OWNER MAILING ADDRESS: srR5r 3020 Rucker Ave. <br /> cm,. Everett <br /> sIATE WA „,98201 <br /> OWNER PHONE:(425) 339-5200 OWNER EMAIL:N/A <br /> CONTRACTOR NAME: Seahurst Electric, Inc. <br /> CONTRACTOR ADDRESS: $1R 2915 Chestnut St. <br /> crrr Everett STATE WA „ 98201 <br /> CONTRACTOR PHONE:(425) 258-1882 'CONTRACTOR EMAIL:dleblanC@SeahUrst.COm <br /> CONTRACTOR LIC.thREQUIRED}:SEAHUE1099QN CITY OF EVERETT BUSINESS LIC.*REQUIRED):18763 <br /> PRIMARY CONTACT: DOWNER ®CONTRACTOR DOTHER(Please Specify) „,, <br /> CONTACT NAME: CONTACT PHONE:(425) 258-5143 <br /> Dave LeBlanc <br /> CONTACT EMAIL:dIt'blanc@seahurst.com <br /> AGREEMENT I herebycar* <br /> rfirtj°that 1 have read end examined this application and know the same to be Prue arta correct. All pravt�fans 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 l am authorized by the owner of this property la perform the work for which application as made and I <br /> comply with the State Contractors Law 18.27 RCW and 298,200 WRC. _ City of Everett Official Use Only <br /> PERMIT#. <br /> � `" Eq <br /> i0(c, 0R--(c, <br /> OwnertAuthoriz Agent Signature Dale (Revised 1/11/2019) Page 1-Application <br />