2120 62ND ST SE 2020-02-25 - Laserfiche WebLink

mil im ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ciao ( ' SE CVG✓ek- knit‘ Azi4 BUILDINGrAREA: GOO sq ft PROJECT TYPE: ❑ NEW CONSTR ION Ell ADDITION El TENANT IMPROVMENT 111 REMODEL BUILDING USE: N SFR .� •WNHO,`SE DUPLEX ❑ADU ElMULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECT i CAL AP LICATION INFORMATION $, DESCRIPTION OF WORK CONTRACT PRICE OF WORK:i:. ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WO';, : ------ �h6-1(a\I baA."-- : ,0-E*e,✓ combo vaoc,akt. boakt, sw0-6ne S a b1( 6{a" THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO l41 YES-Select Scope: El Service El Feeder 71 Circuits-#: i El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio ❑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: qNO El YES--See Below&Pg.2 X 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: NINO 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 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: N lek S� TENANT BUSINESS/ NAME(If Commercial): OWNER MAILING ADDRESS: ]STREET'2.120 `021N ' s t 1 ,r CITYr� ..J Ji 1 STATE LA ZIP 9 g 20. OWNER PHONE:( 2G) 2-2q J2q VP OWNER EMAIL: N. � Y IGI ;IC'N) plus com CONTRACTOR NAME: ("\\I \\tQ),),) JYle\ L1.-C CONTRACTOR ADDRESS: STREET G-00 i--‘16,, Yy zoo CIV CITY C e..Ye STATE A ZIP 3 CONTRACTOR PHONE:C .1:: L`'65--33 3 CONTRACTOR EMAIL: JQ✓G@ flIti 41'21...) �1r1.C,OVV1 CONTRACTOR LIC.#(REQUIRED): t‘IINC N-P g5 7 KZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): I7 -S. PRIMARY CONTACT: EOWNER IXCONTRACTOR 14. 10THER(Please Specify) 3Ov' (Lj2 ) 77o-U767 CONTACT NAME: CONTACT PHONE:( LI2c5) 1-70-P 6Z 1-ar Gcolu400\A a„. CONTACT EMAIL: re4D,f �8 �"Nc� ,v,,. c,avr AGREEMENT:I hereby certify that I have read and examined this application and know the sa a to be true and correct. All prove ions 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#: /Q—.1 fJ 232a� E n o -2,2,2_.O er/ thorized Agent Signature D (Revised 1/11/2019) Page 1-Application