6133 LAKE CHAPLAIN RD 2020-03-09

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits OLT ';-1,,,44440:t;PROJECT SITE INFORMATION PROJECT ADDRESS: 6133 Lake Chaplain Rd. BUILDING AREA: N/A sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION D TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: - Q COMMERCIAL ELEcirFucmgmtexicknowitiFoRmATioN & p ogigotic.0 M..RK, CONTRACT PRICE OF WORK:$ $1,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): N/A DESCRIBE SCOPE OF WORK: Connect Temporary 800KW generator THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO E]YES-Select Scope:El Service 0 Feeder El Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? D NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data LI Intercom Cl Thermostat El Audio El Secure Access El 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. El Other(List All): CODE COMPL.IANCE,..,, , IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: r.) NO El YES--See Below&Pg.2 a 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: ONO OYES-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. k6;.. ,4(4..... :CI NTACTAINFORMATION. ' •=T'a, -, OWNER NAME: Mike Robinson TENANT BUSINESS NAME(If Commercial):COE-Water Filtration Plant OWNER MAILING ADDRESS: sr„ „ 6133 Lake Chaplain Rd. errr Monroe STATE WA 2FE 98272 OWNER PHONE:(425) 257-8203 OWNER EMAIL:mrobinson@everettWa,gov CONTRACTOR NAME: Seahurst Electric CONTRACTOR ADDRESS: STREET 2915 Chestnut St. crry Everett STATE WA 2,, 98201 CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL:reception@Seahurst.COm CONTRACTOR LIC.#(REQUIRED):SEAHUEI099QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: El OWNER ✓❑CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425) 258-5143 Dave LeBlanc CONTACT EMAiL:dleblanc@sehurst.com 'AGREEMENT:I hereby certify that I have read and examined this application end 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! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: t6,0,„J) _ 3-5-19 E 1. 1 05- b Owner/Authors d Agent Ignature DateRevised 1/11/201 ! ) / Page 1-Application (\