1434 GRAND AVE 2020-03-06 - Laserfiche WebLink

maw ELECTRICAL PERMIT APPLICATIO i 1 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 PROJECT SITE INFORMATION PROJECT ADDRESS: J`t/Y C-�2A-r 12 BUILDING AREA: sq ft PROJECT TYPE: C NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ZI REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ ` )--C C� `" ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: l� '"rC J tom! Al.- E-`--. -., (Z. --u3 t j P>i_i--1 J L-- R (A-- '' -`(v)7. -) 1 .3 . ��C._z NJ l Lam- `s-0-2A AK,I THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO g YES-Select Scope: Service r ❑ CI ❑ Circuits-#: �; Complete Re-wire LOW VOLTAGE WORK? NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ 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. ❑Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 4(=1 NO ❑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:1NO 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. CONTACT INFORMATION OWNER NAME: CUi'J O ) D e ‘ig4C 1 ENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET /434-1 6-" J DA--VL-7. CITY L---t, ''`F .�Ti— STATE A- ZIP ICri ) v ' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: C3.-). EINI� ��V =IQ C ,-- CONTRACTOR CONTRACTOR ADDRESS: STREET J o_32...._5 / 67- —,�-��- -S�� ,�1L (('�� ciTY L _ ) (�0‘4411---c d / STATE i'(-0,l-�- ZIP a,..9,,`l,`" CONTRACTOR PHONE:'t2 `tvS `61 '0 CONTRACTOR EMAIL: lG 'E -1 e -� •s l- cj ►'-A c h6r1'V1.c.,t\ C1") CONTRACTOR LIC.#(REQUIRED): L••• i--- ---* -I n q4 i CITY OF EVERETT BUSINESS LIC #(REQUIRED) PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: '1/2-__S---LV -3-1-�� (( C; 1. --(?) , ',�,,� � ► Jfr11 L -L J 'ail CONTACT EMAIL: ,k) t,up,rl 4aL C11ZC_ `�*O \Ik i C-ti AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisiohhs_ flaws 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 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 9 / ? i.s E ��,c( . ��0 Owner/Authorized Ag9 9 ent I nature Date (Revised 1/11/2019) Page 1-Application