5308 S 3RD AVE B 2020-04-03 - Laserfiche WebLink

EtiCTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE,.INF.ORMATION.. PROJECT ADDRESS: 53os 53o3rd Ave,•%)h1 ' BUILDING AREA: iS 1O sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT REMODEL BUILDING USE: J211FR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ;; ELECTRICALtAPPLICATION,INFORMATION,t&,;;DESCRIPTI,ON OF;;WO.RK CONTRACT PRICE OF WORK:$ `15 U .09 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: I' Q1. ) a9 V &CAJ i{" w/ aZ 1A cU 1 hers`4' , Co tttv►,P panel Chan¢, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO YES-Select Scope:OService El FeederCircuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? NO El YES-#of Devices: SELECT SCOPE (REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑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. ❑Other(List All): ;: ;:.• ODE:,COMPLIANCE, . _ ; IS THIS PIIMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:,NO El 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. r-� ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSUREO EYES-See Below&Pg.3 C Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on uildings 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:144i» 5rr TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET s3D$ 3rd Ari CITY E STATE WO' ZIP -1$ OWNER PHONE:ga-8g3_1g41 OWNER EMAIL:rifictiisollft,20603 ma;I . cior", CONTRACTOR NAME: CIS H,PjAn CONTRACTOR ADDRESS: STREET �340 R evekti- ev Crry everty.. STATEIi W% ZIP ) CONTRACTOR PHONE:424010.41CONTRACTOR EMAIL: Stir* Ok S h.eAfi .CAl►1 CONTRACTOR LIC.#(REQUlRED):l; AEA isa15 R„ CITY OF EVERETT 6USINESS LIC. EQUIRED): (pI°SR PRIMARY CONTACT: 'DOWNER .„260NTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 1.40.c..(010 „10 q acJ� Si rm ��/)m CONTACT EMAIL: ,C aft no, * _ AGREEMENT:I hereby certi6r that l have read and examined this application and know the s me to be rue d orrect. Alrprovisioat 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#: 3a\A. E 101 b4- o! Owner/Authorized Agen Signature Date (Revised 1/17/2019) Page 1-Application