7918 W GLEN DR 2020-03-06 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@evereltwa.gov I www.everettwa.govlpermits PROJECT` SITE INFORMATION PROJECT ADDRESS: --IC 1/V &il/rI i 0 V V J V€.+I "I Q)Z-Q ) BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT `REMODEL BUILDING USE: 'FR El TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS; ❑COMMERCIAL ELECTRICAL APPLICATIONINFORMATION& DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ I(boo ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: up Glp V1CSt VIVJ c/iVCAkil- I THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? 0 NO 40 YES-Select Scope:El Service ❑Feeder circuits-#: _ - ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data 0 Intercom ❑Thermostat ❑Audio El Secure Access 0 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. 0 Other(List All): CODE COMPLIANCES IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO ❑YES-See Below&Pg.2 i l 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:ONO EYES-See Below&Pg.3 r 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:AVI-o-trO vekuisFieAcis TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET-7 IQ) aliN IY �//7� (�^rte /F^�' !y1 CITY €14+ t,, STATE t (r U J L �fP WA. OWNER PHONE: Vi f OWNER EMAIL: V'1 1 CONTRACTOR NAME: in 1 I ot.AG CONTRACTOR ADDRESS: STREET [0�3(v0 I 11111 nI) CITY rt--Ate/ti 1 V JC STATE 019)(2.10q) CONTRACTOR PHONE:4� 7(Q0 32,0-6 EMAIL:i Kl /tai� �� - r �IlOtJ( •C arn CONTRACTOR LIC.#(REQUIRED): iN r"yvi [CGJ7 CITY OF EVERETT BUSINESS Liel(REQUIRED): 0 t- 41 Q(b PRIMARY CONTACT: EOWNER CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4-2G 3Z0 at 4t S J ;) CONTACT EMAIL: I of/ye/v ! t � . QU t AGREEMENT:I hereby certif. that I have re.d and:•aminad this application and know the same to a true and correct. All proviS)ouds of laws and ordinances governing this typo of work will be comple:d whether sp: iiled h:ein 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•••ula ng const ction or the p>Aomta. :of construction. That I em authorized by the owner of this property to perform the work for which application is made and t corn with the Slate••ntr3cto '!r : :nd 296.200 WAC. City of Everett Official Use Only / PERMIT#: ( 4/to /lar E Owner/ thorized Ag;IPature Date (Revised 1/11/2019) Pagel-Application Scanned with CamScanner