3426 TULALIP AVE 2020-04-02 - Laserfiche WebLink

LICTRICAL PERMIT APPLITION CITY OF EVERETT PERMIT SERVICES EVERETT 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 PROJECT ADDRESS: 311hI:5 A off) 0 0 'p� sq ft PROJECT TYPE: ElNEW CONSTRUCTION llre BUILDING AREA:ADDITION ❑TENANT IMPROVMENT2EMODEL BUILDING USE: ►/ SFR El TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL CONTRACT PRICE OF WORK:$ 10 (6)0© ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Re q,7� re ( j i,"z all;—hob-hob q,1/ +1/b-r LJ)'cr'y � and by cJq`l . -servitc ' THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ILTYES-Select Scope:I21 Service 'Feeder El Circuits-#:2 O Complete Re-wire LOW VOLTAGE WORK? 121 NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: �. NO III 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE RINO OYES-See Below&Pg.3 I ' 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 exemptiongpyfrom this licensing/certification requirement.NVIVVIVAM' ::. ... Mt ` ,` ,. ro L»�.. 101 4:rR''.144 ssv k :4 �.�,", e3. . cam„'`,. „,,, OWNER NAME: / - m;ch n e 1/ H0grq 141 NT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS:366 STREET IIA(q I / A v e, CITY E 1,0 -- STATE IA 14 - ZIP - -- OWNER PHONE: 'OWNER EMAIL: CONTRACTOR NAME: EIoesky, e r`C CONTRACTOR ADDRESS:(3531 STREET 2 S 411 n ,��//�-� ' / CITY L I�k4. '" !S Ue i S - STATE IA/4 ZIP 1 s CONTRACTOR PHONE: 1125-76 0 2C 'CONTRACTOR �EMAIL:1r/ryq , J /wesky -1 rl'c , l• 'I CONTRACTOR LIC.#(REQUIRED): -13(�te (� , 110.24d CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Q 6607 PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4(2 5- ! CO 6'2 S J3r ya h Re tier CONTACT EMAIL: 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 lam 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#: ii (3- f4_ (9 E 112 _ c02 O •-rl•ut orized Agent Signature Date (Revised 1/11/2019) Page 1-Application