3003 W CASINO RD BLDG 40-05 2020-04-01

ELECTRICAL PERMIT APPLICATIO'< CITY OF EVERETT PERMIT SERVICES EVERETT 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 PROJECT SITE INFORMATION., yU"U BUILDING AREA: sq ft PROJECT ADDRESS: ��:r, S 4 $�a�U 4,..Q1 '_ PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT hJ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION 4,DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ S",5"; U C ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ‘ A'i 2,14d e C a R. i4-) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 171 NO r❑YES-Select Scope: CI Service CI Feeder CI Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? CIL .NO YES-#of Devices: 0('CS 5 714 AN-7 SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat ❑ Audio El 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: El 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: ENO 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: GI 1‘ L TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET / . (} px 37177 rn $ ) - c) CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET c ( (,l �� J f AA) Q) ^� CITY Cn y,L I`� STATE tA W ZIP 9 / CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) - ') ;'G p„ 843 Lk CITY OF EVERETT BUSINESS LIC.#(REQUIRED): rj ..S`. 9 PRIMARY CONTACT: DOWNER CONTRACTOR [G]6THER(Please Specify) tom. _ . it CONTACT NAME: CONTACT PHONE: a&G --7 y3a '/ �/'7 W 11;r 4k to to CONTACT EMAIL: 6iiti e- A cp -�j� 4,�v p,/'V -G 7-- AGREEMENT:I hereby certify that I have read and examined this application and know the same be true and correct. All pro sio s 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#: 1614:f 7;/-//' ; ' ,)// E1°1 \ \ - � nerlAuthorized Agent Signature ate (Revised 1/11/2019) Page 1-A plication C