10210 EVERGREEN WAY 2020-03-06 - Laserfiche WebLink

d orerr. ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION ; ' PROJECT ADDRESS: tO2t0 Fi.iercie2k Waci BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION! 0 TENANT IMPROVMENT gl REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU ❑ MULTI-FAMILY-#OF UNITS: `D COMMERCIAL ELECTRICAL;APPLICATION:INFORMATION & DESCRIPTION OF WORK = CONTRACT PRICE OF WORK:$ 1 I<72_1- 1?Ci ASSOCIATED BUILDING PERMIT#(if applicable): \q Z, G (3 DESCRIBE SCOPE OF WORK: ''.120.,f)0(i;, ,, k A u! Il V-c° cocji--k e_2(--s--sAAd li(-JO(-JOs c..c,c F-c t -2__("4 --.4 / -.4 ( vili, It 114c 17;1C_,,, . k,)(-)9i. ? fL it\p 2taLQ) c 1 - k - -4 7 L ?((t, -2 (t G0 r 1d2.- ( )c Is: Te) p5 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? >2 'NO pil YES-Select Scope: 0 Service 0 Feeder 10 Circuits-#: lag 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 Security System 0 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 PERMITe CODE-COMPLIANCE EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ;El 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-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 YOUOWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: FINO OYES-See Below&Pg. 3 AN ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on b 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. CONT ACT INFORMATION , _ OWNER NAME: \;ere"�- 'V1• 1...-i...-L TENANT BUSINESS NAME(If Commercial): s-1-- V )-C-STt 12-k) OWNER MAILING ADDRESS: STREET --- 5-0:C;)CD \. 9:1-t45`( ) SCA:-y k I a l. CITY ---kjVI L4.4.0A- STATE `/`/A ZIP 4_607U( OWNER PHONE , 4'2 U Iv3i-j 3\, OWNER EMAIL 1 Z'S... L;,.u. �.k4Yt . "c.), ... . M....„.. .. CONTRACTOR NAME: (��V"I'C f,'2\ CONTRACTOR ADDRESS: STREET /� �-� (�.^� CITY y_-i,y 231. STATE \&) / • ZIP - ,caoA L4 CONTRACTOR PHONE:(1125)4370-I-C S CONTRACTOR/ EMAIL: )V\()�"2� (:),VA(:),VAi(..-v^?,1 j)vl(,t.),(CJ CONTRACTOR LIC.#(REQUIRED) OFT I��l c�C) cr„,, ` CITY OF EVERETT BUSINESS LIC #(REQUIRED) S5 3-s- PRIMARY CONTACT: 0 OWNER ( CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: C / e7 -ik(3 )— \ .c} A4J 7 (747 CONTACT EMAIL: rl ese2(. t:iiie l '6 11:; _,• l C AGREEMENT I hereby certify that I ave read and examined this application and know the s�e to bd true and correct. Tall pros of laws and ordinances governing this type of work will be complet#d wl)eth: 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, ,, s tion th?pert.mance 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 ate Co-tracto La', 18. f RCW and 2°6.200 WAC. City of Everett Official Use Only PERMIT#: E 1g 0� -./to _____, �� (Revised 1/11/2019) Pae 1- Iication OwnerlAuthoriz:dRgent nature Date / 9 pp l