4105 FEDERAL AVE 2020-02-07 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 y885//7 1(E)everetteps@everettwa.gov I vvww.everettwa.gov/Permits -A R. s' N N M `�` l s PRO 6�J�"`�i7IVAI lei E (� O yZ'v.Z•j xi ..`e;,a.....��'M-- S..�.:'�.�.� ...._�.\..'`.-i.>...�,,.. 4. �. �°. ..>.: x� r c e_4.,. -; �....._ ti.„.7.._x^.1,.. .,_a ...,....._ _.�4.�er.. .. PROJECT ADDRESS: 1 DS F€QA U A\I (BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT XREMODEL BUILDING USE: SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: COMMERCIAL MANSURRALECIRWAVAMPArONA1[tilMOMP'1(OISMEESPRAMi11 ONOWIONSKSM CONTRACT PRICE OF WORK:$ 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: pan-TA L- -L)is_ THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service Feeder Circuits-#: rgi 0 Complete Re-wire LOW VOLTAGE WORK? ❑NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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): p/► xX _ c gam; - `ss $ .` � .t 4YAODE 9MpL1FYRC is ''c' NS .,'�•-<� � Q x, `<},i'�,��. " L�expM_£�'1 a:__ IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: L�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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®YES-See Below&Pg.3 0 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 Y.., _y ^e,.k k,.." VV,S"4 ? 'yw',ar'-.a"a-.z.,$ Mti i CQ OR OION �S ENSz:''4z. 'C'vre_.YM,'"ti,:W ..W,3.,,.. :.M OWNER NAME: C'A'LL- 1h (ESA\ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET -� ()Gf .A L.. �C CITY E _HT1 STATE •' 7 ZIP 203. OWNER PHONE: '7-64Q... OWNER EMAIL: CONTRACTOR NAME: Ke CONTRACTOR ADDRESS: STREET P� ars, \1 LJ STATE ZIP 93 296 G% i CONTRACTOR PHONE:142,5-3:37- 39/ICONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): te[ e. L LCITY OF EVERETT BUSINESS LIC. D): '#(REQUIRES D PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) '`� CONTACT NAME: CONTACT PHONE: 1426-- '7 / DAN v( F--,A ") CONTACT EMAIL: AGREEMENT:I hereby certify that 1 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 wor rk for Ewhicht Opic licaatli n Use Only ye is and I comply with the S to Contractors Law 18.27 RCW and 296.200 WAC. CitPERMIT#: io/i5E1011. 0 (;141] Date (Revised 1/11/2019) ge 1-ApplicationOwner/Authorized Agent Signature