7709 LOWER RIDGE RD 2020-03-09 - Laserfiche WebLink

MINI ELECTRICAL PERMIT APPLI imiTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits p PROJECT SITE INFORMATION (A PROJECT ADDRESS: 11 O0( .MI LCL VA Ail_ { BUILDING AREA: sq ft PROJECT TYPE: LI CONSTRUCTION ❑ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: M SFR E TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: -Vppk-'-- tkf uV\i a--- 1 6 `thte-irnCLS-ba" THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom }J 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: E- NO 17 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: LINO EYES-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. CONTACT INFORMATION OWNER NAME: I L. , \-` ,t.�, , ( L. V_ L-- TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET -T1I L'CA LeNQZZ '' \(C`VC-- C-6 CITYtat- STATE kits\\CV ZIP rim y OWNER PHONE: I-4-G.•�lJd-g`iSD OWNER EMAIL: ft CONTRACTOR NAME: iO` '\ {jkala ►i'\. * f `J Jc I t,i.5h -Y1. CONTRACTOR ADDRESS: STREET ( /�6 Jit)O .- 1�g n CITY Iv,Cl,—t\�tLLL2., STATE 0A— ZIP CI L CONTRACTOR PHONE: 31.00-402,-(1a0 CONTRACTOR EMAIL: I( ) 9c--•RAMI\�\Q„Q CONTRACTOR LIC.#(REQUIRED): 44 {�(��(o _-f CITY OF EVERETT BUSINESS LIC.U#REQUIRED : ( Cf2 PRIMARY CONTACT: DOWNER ,CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: c 0 ,(QS-E, , &---bo jo_k_yLf, f)(2,f,KAAA.x- CONTACT EMAIL: )/\g_ Y� -) AGREEMENT:I hereby certify that I have read and examined this application and know the same to be trued correc�visions of laws and finances 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#:00' .1L- � I ‘ 5) \ ,22, U-2-0 E )ms Owner/Aut'orize gent/Signature . • Date (Revised 1/11/2019) Page 1-Application I