11014 19TH AVE SE BACK PORCH WINE AND SPIRITS 2020-02-24

IELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 4255-257 88557 1(E)gpevv�eretteps@eveegreettttw�a.goyv I wwweverettwa.gov/Permits „ _ W 4:c �'L VE '� tN- ?.� D4[]EVI R : \ R.cOKKO ' �.�'£"�.BS4Zaz\'=. s \"4�-i S€+}'ryi'^ Ay_ ;\.. t ` � ".: u sq ft PROJECT ADDRESS: I I C5 11 17-71-1 � )e- (BUILDING AREA: PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT REMODEL BUILDING USE: 0 SFR 0 TO WNHAOUSE 0 DUPLEX 0 ADU 0 MULTIFAMILtlY #!SOF UNITS: 0 COMMERCIAL EL6PTR!PP tgV +T O rfl R TION CEPS . `M . rw CONTRACT PRICE OF WORK:$ y O�• OD (ASSOCIATED BUILDING PERMIT#(if applicable): lS • DESCRIBE SCOPE OF WORK: 5. 1 i C. A 1 A t Rk rr v7 N - ea I �"�I^ ems. -} © � / / � ' LJ Li— THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT AFf LY) LINE VOLTAGE WORK? NO itiYES-Select Scope:0 Service 0 Feeder rcuits-#: 5 7 Complete Re-wire LOW VOLTAGE WORK? NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): Data 0 Intercom 0 Thermostat 0 Audioecure Acce0 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. �. r ❑Other(List All):Rti �r }C i r.. ,*.v.,,,MM z.TaR ¢ .: �,_u:.<w. � S VOVO�lt iiR" .c+.a Sx'",t `"*\a' i zi 'k`4SS SMOM YP IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ' NO 0 YES--See Below&Pg.2 ® By checking this box,I am stating that I have read and understand all of WAC 296-46B-911,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 OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: O OYES-See Below&Pg.3 ® Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on ildings 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. tY Y `, n w at a\ + t �"al'ag a �` a� ?x' � 3 IALtir3�>.�. � e tmx „-raw._ ''� `�� <.�a��:'�x�n,�Z��4�,�"±��;��.n tau........ �;.......�: ..,..y Min * OWNER NAME: 0,.00/3tal A I--- JE- NANT BUSINESS NAME(If Commercial): L J . ss `"' OWNER MAILING ADDRESS: STREET 6 STATE ZIP CITY OWNER PHONE: TOWNER EMAIL: CONTRACTOR NAME: K12-,Air k---G' 1 LA`-' CONTRACTOR ADDRESS: STREET PO ia,C5y, CITY �ajC �.-�/ STATE W ZIP CONTRACTOR PHONE: 4 7.6,--.:N61-z59/ CONTRACTOR EMAIL: - eITY OF EVERETT BUSINESS LIC.#(REQUIRED): , 4410. CONTRACTOR LIC.#(REQUIRED): / • c 5 _ ""N'""°`"�"°`"'""��" PRIMARY CONTACT: ❑OWNER X CONTRACTOR 0 OTHER(Please Specify) Z�rS� CONTACT NAME: CONTACT PHONE: ��7� CP-A 1 gsi CONTACT EMAIL: 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 C r of for whieht Opi licatiiai on Use Only ye is and I comply with the St ontractors Law 18.27 RCW and 296.200 WAC. tyPERMIT#: E '90-- -- M1 , I Owner/Aut • gent Signa Date / (Revised 1/11/2019) Page 1-Application