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Aug 04 2019 10: 16PM ^. CONSULTANTS - -5-548-0879 p. 1
<br /> ELECTRICAL PERMIT APPL i ATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVER E TT 3200 CEDAR STREET, EVERETT,WA 98201
<br /> wdst+Ir+crbN. (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteos@everettwa.gov 1 wwvr.everettwa.gov/permits
<br /> MINNi 't i l[4t,t.
<br /> PROJECT ADDRESS: 1 0317 Holly Dr BUILDING AREA: 2200 sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑✓ REMODEL
<br /> BUILDING USE: ❑✓ SFR ❑TOWNHOUSE El DUPLEX LI ADU LI MULTI-FAMILY -#OF UNITS: ❑ COMMERCIAL
<br /> r40.0M4 ' Otl.*A;OW 104 : '1111!.1 ` ' ,
<br /> CONTRACT PRICE OF WORK:$ 3,600 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Power, lighting, and smoke detectors in new framed bedrooms. Add smoke detectors in existing
<br /> bedrooms. Add exterior lighting for walkway and ramp around south side of residence.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO ❑ YES-Select Scope: tEl Service El Feeder n Circuits-#:3 El Complete Re-wire
<br /> LOW VOLTAGE WORK? D NO ❑ YES-#of Devices:
<br /> SELECT SCOPE (REQUIRED): El Data ❑ Intercom ❑ Thermostat ❑Audio U Secure Access ❑ Security System
<br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> ❑ Other(List All):
<br /> �,,.. �k it rt.F`, t:'Y>�t}''xN� ° ter.. /� `.(I,fi 1I :-t li�lc rt ' 1, S 6•i(t �s
<br /> E , `.i.�. �3I��r1 4.>dP�?, � §� .,.i � , 4..e.. �. � � .:...��ii7k 7 Ilt��; . �•� li�. ;Su� r tom, l �;�ii� ,5 wsa '�.v.l -`, k•�
<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: n NO L J YES - See Below&Pg. 2
<br /> By checking this box, I am stating that I have read and understand all of WAC 296-46B-9Q0, selected the specific reason on page 2
<br /> of thls application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO DYES-See Below& Pg. 3
<br /> Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale,or lease
<br /> without the proper electrical licensing and certification,or exemption. By checking This box, I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement,
<br /> OWNER NAME: Tolessa Tesfaye L. TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 10317 Holly Dr
<br /> cnY Everett STATE WA z,F 98204
<br /> OWNER PHONE: OWNER EMAIL:
<br /> .._.... 1,_v.n..,.,..... ,p.,.,...:..a.e............ ...._..... ...........•... p. ...., a...l , .. .. .£1,,, .fl'.. .l .._... �....,u a. «,wgxC.u•u:prr .t 5, ...,,.i. ,........ T. ._..... ��„ ,.
<br /> CONTRACTOR NAME: PWR Consultants & Contracting Inc
<br /> CONTRACTOR ADDRESS: STREEr6910 Roosevelt Way NE PMB 202
<br /> cn,- Seattle STATE WA aP 98115
<br /> CONTRACTOR PHONE:206-898-0585 CONTRACTOR EMAIL:pwrCOnSUltantS@gmail.COm
<br /> CONTRACTOR LIC.#(REOUIRED:PWRCOCI997QF CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60485
<br /> PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-898-0585_
<br /> Philip Rohrner CONTACT EMAIL:pwrconsultantsatjgmail_ oC m
<br /> AGREEMENT:I hereby certify that I have read and examined this application an. .. , same to rue and co.-at. Alii. 'sions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give aut ority to violate or cancel the provisions of any other state or
<br /> 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 1
<br /> comply with The State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT j
<br /> Philip W Rohmer 8/4/19 E `( t T- fiV2 5/
<br /> Owner/Authorized Agent Signature Date (Revised1/11/2019) Page 1-Application
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