Laserfiche WebLink
Lein INICTRICAL PERMIT APPLICgiPrION <br /> CITY OF SETT PERMIT SERVICES <br /> E, 1 <br /> CEI AR STREET,EVERETT,WA 9820T <br /> v+riare notomr (P)425-257- 4 $ FAX 425-257-8857 I(E)eireredepatioverettwa,gov I tintweverenastgovipermits <br /> 17:4- g <br /> PRO J CT ADDRESS 1918 Baker Ave Everett WA .201 . 4 taDiNC .1500 sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: 0 COMMERCIAL <br /> v..: ..tea.. ., <br /> CONTRACT PRICE Of WORK $ 4800.00 ASSOCIATED BUILDING PE IT (if applicable): C' k,/t c I 0 —009- <br /> EScRIBE SCOPE OF WORK; <br /> Rewire House 1600 S <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE K? 0 NO 0 YES Select Scope:0 Service Feeder Circuits*13 21 Complete Re-wire... ; <br /> LOW VOLTAGE WORK? 0 NO 0 YES-it of Devices: <br /> 0 <br /> SELECT SCOPE(REQUIRED):0 Data ,. <br /> Intercom 0 Thermostat Audio 0 Swum Access 0.Security System <br /> 0 Fire Alarm-Installations under this permit only include electrical wking rough-In of the system,An additional <br /> Fire Alarm Permit is required for review of device location and Installation approval. <br /> 0 Other(LSA ) <br /> IS This PERMIT EDUCATION,INSTITIXTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: E4 NO ■ YES--See Below&Pg,2 <br /> DSy checking this boat,i am stating that I have:read and understand all of WAC 29$44$84100,seleMett the specific reason ort page 2 <br /> of this application(see nest page),AND Plan Review is NOT required I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ENO OYES Below&Pg.3 <br /> • Pursuant to RCW 19,28.261,property owners and leaseholders cannot perform electrical on buildings for rent,sale,or lease <br /> • without the proper electrical licensing and certification,or exemption.By checid g 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 licensirigicertification requirement <br /> te.m 7=ke <, .a �-aa•�y3"�`2a„� ,..y,:aa , qa.. <br /> OWNER NAME:Matt Heck TENANT BUSINESS NAME(lf Commercial); <br /> OWNER MAILING REsT EET 14419 Greenwood•Suds 147 <br /> err,; Seattle sit WA zap 98133 <br /> OVVNER PHONE: 2# - , +fNER EM .: <br /> ,. .e c NAME. Spectrum Electrical ServicesCo_ <br /> CONTRACTOR ADDRESS; sTREET8809 1st Ave NW <br /> crry Seattle snare VVa zip 98107 <br /> comaacioa pp j ;206-784-1927 'CONTRACTOR Et rnIkewreyO98( "ta , rrl <br /> CONTRACTOR LIC,#(REQUI ):Spe 7lg6 Icrry Of EvERETT susiNess Lam. UIREO,g „54f41---41, <br /> PRIMARY CONTACT: DOWNER CONTRACTOR omER(Please Specify) A <br /> ,CO ITALY NAME: ,}` CONTACT NE:2 -78 -1927 <br /> Md ce Wrey f <br /> AGREEM l yertify thati have reedand examir dJONTACTEMML:flhikewreYo. 9maiLcOm <br /> application know the same rte be true:andwrrect: AS proWsions laws and ordetances governing this <br /> type am*wen be completed whether specified herein or not The g.anting oft(petted does not presume to give authority to violate or cancel the pro ofany other state or <br /> local few regulates;construction or the perfonnance of construction, That t amauthorized by the owner oftto parson the worik for which application is mote and I <br /> retro*with the State Contractors Law 18.27 RCW and 296200 WAC. City of Everett OMcIat Um Only <br /> PERMIT <br /> //tie el tql0"-- ( <br /> Ower/Authorized Agent Date (Revised 1/1112019) Page 1-Application <br />