1710 100TH PL SE 2020-02-25 - Laserfiche WebLink

`! 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1'i/0 7OO1t PLC S, r'Vtre i- /,,J4 IBUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL'APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ �860� ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 7,4S-pt- it ,4AU.t 2/? , I;r¢ � �=SGtr THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO El YES-Select Scope:El Service El Feeder El Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO BYES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El intercom El Thermostat El 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: Zi NO El 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:gNO EYES-See Below&Pg.3 1111 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 en page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: tit k M mc.I,Grt TENANT BUSINESS NAME(If Commercial): ij`;l urn- L.M Pro sec,.+ail OWNER MAILING ADDRESS: STREET /7/0 j00 Z j e. *t 98246 cm,' STATE ZIP OWNER PHONE: ZQto" 7/,S— :1000 OWNER EMAIL: CONTRACTOR NAME: ( p,/riieviec Ar CONTRACTOR ADDRESS: STREET J7/f 9 eoll..40ee 7 - CITY I kFG _] :4 a' / STATE A"'A# ZIP 91/2 73 CONTRACTOR PHONE: 56y 86/ gygs 'CONTRACTOR EMAIL: T „flee I.,et fr2. t)ir+ CONTRACTOR LIC.#(REQUIRED): [nay , 4}f 998L0 (CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1.450/ PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: -'0G? 9(. 9 cYeg� r arra Se/I,‘:k. CONTACT EMAIL: ,-.J e CFl 5,,D to • C.•o:�-� AGREEMENT..I hereby car*that I have read and examined this application and know the same to be true end conedt. Al!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 Contrac... l w 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: P' -/ - i9��pI/ I E b( l orzed Agent Signature Date (Revised 1l11l2019) Page 1-Application