1201 SE EVERETT MALL WAY FURNITURE TO GO 2020-02-06

ELI tLECTRICAL PERMIT APPLIuATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.govwww.everettwa.gov/permits 1 PROJECT�ySITE INFORMATION PROJECT ADDRESS: 0--.0t oe/�C rl "\O H Nay BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 5)0,00 ` KS BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: \1 IS�(It\I (1 ) KS radii) '1() 'v\Jyl i 1Or ic1-Iy THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 'NO ❑YES-Select Scope: Cl Service ❑ Feeder ❑ Circuits-#:_ ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO EYES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio El 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 ❑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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO DYES-See Below&Pg. 3 nl l 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:(1_116 U� SSoPdCl+e J TENANT-BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET l G1� �N"3 {v 9 v ALlv\--1 j L,1--t 30'2- �� `/'�' / CITY ��jGY STATE V ZIP 1 OWNER PHONE: 3C�2 '- CL) I' -"0 / i I`k CAD\1! �r CIV 1 ETV) OWNER EMAIL: ��G�t�L✓ t/ CONTRACTOR NAME: el JC 'O Vin �crl 1 �c CONTRACTOR ADDRESS: STREET \ - r\V-1-1 � Pu k01CITY - ( STATE µ ZIP q CONTRACTOR PHONE:20(0j02.2-- ((gl") CONTRACTOR EMAIL: e� VIQX 3ol on' - CONTRACTOR LIC.#(REQUIRED): ee ss Z3� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ' �y 3 PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: �( \\'-(2-)1 n CONTACT PHONE: Q �` 2. C� )(t 2--7-1 / T/1 S T n`�-)I/ CONTACT EMAIL: e jquy l7` �� (GiV� ( (/V( "tom/ r�,t AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and cor/8ct. 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 PERMIT#: ; JIA 7 i DL-0-2J0111 - c52 Owner/A thorized Agent ignature Date (Revised 1/11/2019) Page 1-Application