1321 COLBY AVE 2ND FLOOR 2021-02-17

LI ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (F)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: I 2-( C., 1 .J i};„ BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT N,REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK / CONTRACT PRICE OF WORK:$ 2421 0. (£/0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: A/2443 'Pitarwta.c / s paces- .i Leiv Lk 2 t 4 C t".` j t'..'es„deti -,5 c�� 1-f6), c 3 r(rb 2 x + Pc,,,.g e,-I CI- r ' THIS INSTALLATION INCLUDES THE FOLLOWINGrSCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO I YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: .Complete Re-wire LOW VOLTAGE WORK? El NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional 1?1 ire Alarm Permit is required for review of device location and installation approval. 5 Other(List All): P.OP/54'_ i ON iy d0,4-4.7 door, CCTV, SCC.u.n 1 CODE`-COMPLIANCE;'' IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO /OYES--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:17NO DYES-See Below&Pg.3 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on tbiildings 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: e;,.; Ltbtce. ICOSi ia( Aiteelic.4 TENANT^ BUSINESS NAMEa (IfIfCommercial): OWNER MAILING ADDRESS: STREET 100 i 1 °IA A+v E: 50 4F— /O1 CITY keit+U'1 STATE 143 4 ZIP %DS.-- OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 1,/ .Ie_C-Fr (-- CONTRACTOR —CONTRACTOR ADDRESS: STREET szt, I4 14' �t)r�� p �� CITY S�'i'i'�7I) C� C STATE ��'1� ZIP- � i 08 CONTRACTOR PHONE: V i'..71"c tC'=5112Ate CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OC)i.4 1 5 C,7e (PleaseSpecify) rlcl -tz,-z. ( r-c,-t�rctet PRIMARY CONTACT: DOWNER ❑CONTRACTOR , OTHER eclfy)S CONTACT NAME: CONTACT PHONE: 2.0G2 116-0 .."-?- 3/3 -1(1Sci Sc LUtt ie-(a CONTACT EMAIL: _;.,sc''yt,. SceloenAta la AGREEMENT:I hereby certify that I have read and examined this application and 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /jig— --4-/w,,/, c� Qg - oc, ( I 0.2 /Authorized/ ignature Dat (Revised 1/11/2019) Page 1-Application