11610 EVERGREEN WAY 2020-02-07 - Laserfiche WebLink

Nos `I ECTRICAL PERMIT APPLIUMTION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.govIpermits • PROJECT ADDRESS v =� -,; ,PirvJ BUILDING AREA: (in c sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 4 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR (71 TOWNHOUSE CIDUPLEX CIADU El MULTI-FAMILY-#OF UNITS: �yy COMMERCIAL yy CONTRACT PRICE OF WORK:$ 3, 0,3 ` ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: f °i L - y) c r G Is:Jr tnej.joIs:, 0,44 k LdC . . THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? M NO ❑YES-Select Scope: ❑Service El Feeder El Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? Il NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑ 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO Cn 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: 7NO EYES-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 f 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. OWNER NAME: TENANT BUSINESS NAME(If Commercial): PAK0A ? s ri�frok.,,y OWNER MAILING ADDRESS: 6,RSTREET ),}t fir) CITY " `r �C":.t7 L p> STATE ( A LIP Cif I "::,(1•.f;._ f OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ->$ L..B e KAI 003. '',-. ` "O CONTRACTOR ADDRESS: /SV STREET f00 . CITY • J'"ICI.1Yr)& STATE �rJ- ZIP • . `, .' .-` ......, • CONTRACTOR PHONE:75 5-Y _of q 4 CONTRACTOR EMAIL-, c)Cr -s „ 0,4-1 CONTRACTOR LIC.#(REQUIRED) '} (40r) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ,S"°; (j-2 '- PRIMARY CONTACT: DOWNER [CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 'J .- „0 . z CONTACT EMAIL: J t S.0 (& T+ t<'cl- 4 0 el,,.. AGREEMENT.1 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 1 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#: ""owner/AuthorizedAgent Signature '� Date (Revised 1/11/2019) Page 1-Application