4129 GRAND AVE 2020-03-06 - Laserfiche WebLink

ELECTRICAL PERMIT APPLILMTION EVERETT CITY OF EVERETT PERMIT SERVICES 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 'PROSECTStrt INFORMATION X” ,, . .. PROJECT ADDRESS: 4129 GRAND AVE EVERETT WA 98203 BUILDING AREA: 500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT LI®'ODEL BUILDING USE:x ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION ikDESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ $2000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: adding new circuits for kitchen ,washer and some outlets THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#:5 ❑ 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: ✓❑ 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: ✓❑NO EYES-See Below&Pg. 3 ✓ Pursuant RCW 19. . , oeu , , without theto proper elec28trical261licensprinpertyg andowners certificationand , or exemption.leaseholders cannot By checkperforminelg thisctrical box, I amworkon statingbthatildings Ifor haverentcompleted saleor lease and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. r: tO T INFOR ATIONe OWNER NAME: Fisher TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4129 GRAND AVE CITY EVERETT STATE VVA ZIP 98203 OWNER PHONE: 2069602397 OWNER EMAIL: CONTRACTOR NAME: BRIGHT& RIGHT ELECTRICAL SERVICES LLC CONTRACTOR ADDRESS: STREET23825 45TH AVE SE ciTr BOTHELL STATE WA ZIP 98021 CONTRACTOR PHONE:206-960-2397 CONTRACTOR EMAIL:BRIGHTANDRIGHT@YAHOO.COM CONTRACTOR LIC.#(REQUIRED):BRIGHRE839DA CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 58515 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-960-2397 DANIEL MOGOVAN CONTACT EMAIL:BRIGHTANDRIGHT@YAHOO.COM 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 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#:E 8/9/2019 \ ClUZ (97-) �(J Owner/Auorized Agent Signature Date1/11/2019 Revised Page 1-Application ( ) pplicat on