6918 COLBY AVE 2020-02-06 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 [ FAX 425-257-8857 I(E)everettepsaeeverettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 02 BUILDING AREA: 01 CVO sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT 51 REMODEL BUILDING USE: CitsFR El TOWNHOUSE El DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL E EC CAL•APpI* $INFOR , IO$ DES RJPT'IDN'OP WORK CONTRACT PRICE OF WORK:S 1 j t!fl? • 'ASSOCIATED BUILDING PERMIT (if applicable): DESCRIBE SCOPE OF WORK: pe _. (,t.;"rD re. S e'r v let €€-U i" a rr fa) 014-CC Liu,Id 4- 114 Lrn Y 3f THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑Service El Feeder ❑Circuits-#: faCompiete Re-wire LOW VOLTAGE WORK? ❑NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑Intercom ❑Thermostat ❑Audio Cl Secure Access ❑ Security System ❑ 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 Li 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:fRNO 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. .. - ONtACT OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: srisr j, ''( i i°1 v O.Oa Ave CITY VAid.4 e- 1 STATE 1,0A OWNER PHONE:(' ) ?1 ' —( 5gl OWNER EMAIL: y I" hex tvi y154e 2(a a,to-02 CONTRACTOR NAME: 13 O SCI4 Lg CT12 I C I N C. CONTRACTOR ADDRESS: STREET PC` �6 Z7 kSy 16 ?)3 t A �j Q .t dm, I IkI G i V c •, STATE I,N zip "1 c7 L 5B CONTRACTOR PHONE: '4I,6 3 gel Sri tQ 6 CONTRACTOR EMAIL: be s c h e(tc Yi cera. @ ou.rt c COW,. CONTRACTOR LIG.#(REQUIRED): BOSCI-IEIA(13 0r CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 041;211 PRIMARY CONTACT: DOWNER EXCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 442,6 :36r7 g '7( 0 � �.�`j eJ -12.2, qui Toe SO 5 C ii' CONTACT EMAIL: 0‘C(,t. e.I t C ,Loc,c €4, o t,c,t r oo i:,.C,ew, AGREEMENT:I hereby certify that I have read and examined this application and know the same to be 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 Oni PERMIT#: `1 E / Owner/ uthlorized Agent Signature Date (Revised 1/11/2019) Page 1-Application