707 GRAND AVE 2020-03-06 - Laserfiche WebLink

inn II: ELECTRICAL PERMIT APPLICATION EV E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 Z. , WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@evereltwa.gov( WWW.evere!two.goyipermils "x' PROJECT SITE INFORMATION :" PROJECT ADDRESS: 10-1 6t Uva Ot 19.12-0lBUILDING AREA: spft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL.APPLICATION INFORMATION&DESCRIPTION OE 1 O CONTRACT PRICE OF WORK:$ ,ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: PallitiCU t44.41ke p (/l/I(e, ILO (tiC.(u o € .'t 11V1e'I Coin/ (l main ftgpv- a✓0&YY\S, w tti o-ffirre-, Lit psi a ids toed vzx3,m s 8, lou-t-() wi rD 1 ) 4- 1 r h M 4J, oAnA'\a-5 THIS INSTALLATION INCLUDES THE FOL WING SCOPE:(SELECT ALL THAT APPLY) 0Y 1,.'1( LINE VOLTAGE WORK? 2NO YES-Select Scope:❑Service ❑Feeder ❑Circuits-#: -.-arr. tp+ete Re-wire LOW VOLTAGE WORK? NO ❑YES-#of Devices: are SELECT SCOPEREQUIRED: El Data ( CI Intercom ED Thermostat ❑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. E. r� ❑Other(List All): CODE COMPLIANCEAtigt IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO ❑YES-See Below&Pg.2 ,,,; j] 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 20. ' ( 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:❑NO 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 fr See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensinglcerti(cetion requirement. CONTACT INFORMATION N Via, OWNER NAME: p r t v I &-101 cAY TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET I l01 0111-A � yCi CRY -6\i '("64. STATE �A 2:p.°19)2-01 ,. OWNER PHONE: V'1 4\ p�O�,WNER EMAIL: (� CONTRACTOR NAME: \)0 k1" ASe 0-I`�ffil Ci CONTRACTOR ADDRESS: STREET�I/�� C-50 1't `- T-)\'- t� Q (� cm lave 5t4C "� ��j��yy� STATE (A Tl zip 19)2°`O CONTRACTOR PHONE: A2P-10 3�3 CONTRACTOR EMAIL: IVI�i f `"k -6 3 F(1(\CA--k\ • C.-G-r 1 CONTRACTOR LIC.#(REQUIRED):\ OU 2 Q C 1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0141-"\-\\...9q PRIMARY CONTACT: DOWNER ❑CONTRACTOR RloTHER(Please Specify) CONTACT NAME: [,� t��^/ CONTACT PHONE: 4'.' "(a(7 3'2.03fT/l " l CONTACT EMAIL: 9(If\V C)).4 c(_,C LL-t l(.--• O01,11,-, AGREEMENT:I hereby certify that I have road and examined this application and know the same to be rue and correct. All provisions of laws and ordinances governing this t< type of work will be completed whether specified herein or not. The granting of a permit dons not presume to give authority to violate or cancel the provisions of any other stale or local taw regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work far which application Is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#:,_�I i r✓i f/1 /1 q E ' 1 I �• ner/Auth•/11gent S gnature Date (Revised 1/11/2019) Page 1-Application Scanned with CamScanner