5717 GLENWOOD AVE 2020-03-06 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 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 SITE INFpRIVIATIQN„>' ., •. ,. . PROJECT ADDRESS: C1�QV' L J 00c AVS-- BUILDING AREA: 2.- sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL LX.BUILDING USE: lX SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICALAPPLMCATION INFORMATION IIESGR[PTION OF1l OWV CONTRACT PRICE OF WORK:$ 7.000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: N Ew i 'V`S,_I vi/k&n.I w KT—e THIS INSTALLATION INCLUDES TH FOLLOWING SCOPE: (SELECTr�1ALL THAT APPLY) LINE VOLTAGE WORK? NO %YES-Select Scope: Service ❑ Feeder ❑Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ 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. E Other(List All): • CODEQNIPLIANCE . • IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © 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: ONO 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 1NPORMATI©N OWNER NAME: tcw\ VIGI/$ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET IQ 21 -Ve-✓tJ r2lc Wel S 2 S Lite CITY w STATE 5 V(]y ZIP OWNER PHONE(42_S')iet I 171'2_ OWNER EMAIL lJ4h -Q-WI �U rhot1 1 cow, CONTRACTOR NAME: 1- )- 1-ec1 t' L, (dl C_ CONTRACTOR ADDRESS: STREET 0 BoX 13 Ce /� V.2' CITY E�/Y.e.-f/ STATEPt/Pt ZIP ®Z / v CONTRACTOR PHONE: I -5 `, 3-7(f67CONTRACTOR EMAIL: l J rcA �`J J)r reCie 14,1 CONTRACTOR LIC.#(REQUIRED) r0.4.,e,T S 2Z B r CITY OF EVERETT BUSINESS LIC #(REQUIRED): 543 PRIMARY CONTACT: DOWNER MCONTRACTOR ❑OTHER(Please Specify) CONT CT NAME: CONTACT PHONE: 14-2.5 3 it-5 - 3 7((/S c)��CU&) V\ "ickCONTACT EMAIL: S U �q �C� �1�at i &l e_c-1r(L /✓l c.. . AGREEMENT:I hereby certify that I have read and examined 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 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 the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /Z° E Zoo c — w5 Owner/•uthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application