2603 E GRAND AVE 2020-03-06 - Laserfiche WebLink

Alp , CTRICAL PERMIT APPL TION /' � CITY OF EVERETT PERMIT SERVICE ��- 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATIOh1, ADDRESS: C 0 -3L-- 61. 144?-- BUILDING AREA: .i ) PROJECT sq PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El L R TENANT IMPROVMENTREMODEL ' / ft BUILDING USE: VIrSge, ❑TOWNHOUSE El DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 0) /0. ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: , <"..J ;r 1,44'0 C.,k. dei, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 54 YES-Select Scope: El Service ❑ Feeder El Circuits-#: Complete Re-wire LOW VOLTAGE WORK? p.4.0 ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom El Thermostat ❑Audio El Secure Access El Security System El 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: JO ❑YES--See Below&Pg.2 El 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 2require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE. MI DYES-See Below&Pg, 3 17; a°' Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buil.Ings 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 Pag 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: IKT.At ci ' it t lj,t i",t(cz,eit to''ENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP 1 OWNER PHONE: a+;�&" �� 'c e`a v1•WNER EMAIL: / CONTRACTOR NAME: e -(.1 C.-c t`,c_. , m,�,A�l. ye /( Llr�.. CONTRACTOR ADDRESS: STREET I>o CITY " � vcp �-� � VP e STATE LptJ tom- ZIP CONTRACTOR PHONE: ' ‘'i2 2141 f Z7. CONTRACTOR EMAIL:)-'rig? `(7- 6 v v'a ;=->i viAr1 ,� l c t7I°' CONTRACTOR LIC.#(REQUIRED): ilm,P, PFfit 1112D 1/ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (2417l PRIMARY CONTACT: El OWNER Cy.4214TRACTOR ❑OTHER(Please Specify) CO TACT NAME: CONTACT PHONE: x"/'25 6---q -. 4,,q14--)� CONTACT EMAIL: ) 4evil 0,;5 k b,6,1_, - AGREEM :I h eby ceftify tt t I have read and examined this application and know the same to be tru and correct. All provisions of laws and ordi(�a ces governing this type of wo will be completed whether specified herein or not. The granting of a permit does not presurc.e give authority to violate or cancel the prov/s ns 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#: / — q E W lgoA 00P Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 11Applicati