1703 GRAND AVE 2020-03-06 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM 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@everettwa.gov I www.everettwa.gov/permits 4E77 PROJECT SITE INFORMATIONt PROJECT ADDRESS: f70 &I(tAta /91//2;- /�Oereit PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION I TENANT IMPROVMENT 0 REMODEL BUILDING USE: R.SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 600 C C ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: -JSf'i(l Ciecfti'td( O( A043 5Plt:f" i,140-ii- /tom P14-44-9) THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ® 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑ 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: ba,s b L'fl Ldher-ervice. TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET / 703 bra frtdILer P/vIe('eM CITY lAkSTATE ZIP 4 rzo I OWNER PHONE: OWNER EMAIL: 9/ CONTRACTOR NAME: �� 1.�` � 'Qc %Y SIT 9/ dit`Cal CND r 1/l.�i CONTRACTOR ADDRESS: STREET 170�/, ""r'f 2p ./vc1 ST �J -y CITY /r`tt ry�V F`1 Ce` STATE (,c94 ZIP Z.!O // CONTRACTOR PHONE:3CO-c 1` -064O/I CONTRACTOR EMAIL: f1it;1; bit/CS y of eC r)(C A 'Af a,COM CONTRACTOR L!C.#(REQUIRED) L()/�(,,e.C, CITY OF EVERETT BUSINESS/LIC.#(REQUIRED): J PRIMARY CONTACT: 0 OWNER VI CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: r^` CONTACT PHONE: so) y 00/I AVte ces'1f r� CONTACT EMAIL: /joiec 77blt, kye/ I`Gip �y, 1 y r© ► 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 a and I comply with t State Contractors Law 18.27 RCW and 296.200 WAC. / City of Everett Official Use Only PERMIT ,e1 61 k,..---• 1 T72 •wner ,uthorized Agen Signature ate (Revised 10/30/2018) e 1 of 3