2809 FOREST VIEW DR 2020-03-06 - Laserfiche WebLink

Imo cel ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 (F)425-257-8810 I FAX 425-257-8857 I(E)evaretteps@everettwa.gov I wwweverettwa.gov/eermits WASIONaT01.4 PROJECT SITE INFO- ":TION PROJECT ADDRESS: i..q:)001 fOVS1 V b V BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT EMODEL BUILDING USE: EISFR ID TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: El COMMERCIAL 4/ : 57EECTRITAL:TA L5 ftCtftMM30**DgsCRWIOWOVN0Rtfki,,I,4;,'':M;S CONTRACT PRICE OF WORK:$ 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 2-00 etryto THIS INSTALLATION INCLUDES THE FOLLpWING SCOPE: (SEL/ECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 11111 YES-Select Scope: Ile Service El Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? NiNO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom El Thermostat El Audio El Secure Access El Security System El 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. El Other(List All): CODE COMPLIANCE' ',,' ,.' IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: n NO al YES--See Below&Pg.2 UBy 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: 1:INO DYES-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. OWNER NAME: 9.0i‘,/rn h 1 1-bvi not It-WV- TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2)00(71 -FOr -t Vitiv1/41 1)Y .Fv's/rerti- STATE VV ZIP g 92O' ' OWNER PHONE: 01/4- OWNER EMAIL: V\ OIL' CONTRACTOR NAME: ( e1e4Y10 CONTRACTOR ADDRESS: STREETf( 7O17-tici DYS Epy 1,0, e.-StOve4/1 STATE vv zip g(612.- Q) CONTRACTOR PHONE:442.0•1t2 CONTRACTOR EMAIL: on-cpekm\--tg OlOti •60 al CONTRACTOR LIC.#(REOUIRED): k)l-frEA ICITY OF EVERETT BUSINESS LIC.#(REOUIRED): 0 Li t4 teQ) PRIMARY CONTACT: DOWNER ONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 42.S -TWO 32.-0 CONTACT EMAIL: vinockTyli-rs ifyla.„( ,c/ovr AGREEMENT:I hereby certify that I have read a • "ned 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 specir herein o 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 construe`.n or the pa •rrnan • co stniction. That am authorized by the owner of this property to perform the work for which application is made and I comply with •e State Co rectors Law z.2T r Wend'95_200 WAC. City of Everett Official Use Only PERMIT#: IfT(7-040 E r--' Owneil• thorized Agent SignLture Date (Revised 1/1112019) Page 1-Application