3420 BELL AVE 2020-05-04 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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 I www.everettwa.gov/permitp„ PROJECT.SITE INFORMATION • _" _ • PROJECT ADDRESS: 3'. O �L!e C k" `) �j ��/'� BUILDING A A: sq ft ,` PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT E DEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS' u COMMERCIAL ELECTRICAL,APPLICATION-INFORMATION 8. DESCRIPTION;OF°-WORK' CONTRACT PRICE OF WORK:$ /45-a73 , ASSOCIATED BUILDING PERMIT#(if applicable): /2/ck(j.- / 3 DESCRIBE SCOPE OF WORK: {/.,lb t'VL `re 320 rfsrs /c' I -r(-' e- 2 477 i/ Tn /A/Lc t �C/GZ /1iC/L-G`� r -` l --C) �O THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO Er-YES-Select Scope:❑Service EfFeeder ❑ Circuits-#: 7 ❑Complete Re-wire LOW VOLTAGE WORK? I]ANO ❑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. El Other(List All): CODE;COMPLIANCE `: .. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: n-1:10 ❑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: NO 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: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3Z/Z 0 Z- 4 CITY 64-Jfi- STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: \,JV* L L.t=i✓�-� C f /�y�C . CONTRACTOR ADDRESS: STREET 2 CYC)Z t3,1 �=; _ /21) CITY gGY" ZL STATE Z1,41- ZIP � c CONTRACTOR PHONE: L '2��u Lu z�/�j c> �I'CONTRACTOR EMAIL: ‘,1,5'�&-'c'7 rV7C CO(, l CONTRACTOR LIC.#(REQUIRED) CSELEE11-7;7(c' OL CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 7 PRIMARY CONTACT: DOWNER ONTRACTOR ❑OTHER(Please Specify) CONTACT CONTACT PHONE: .//7J0c 2re,_g87.� c) JC 6� V/ / L©2-5 CONTACT EMAIL: ✓5- e/e -f 77 cyok 7 AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of-I ws 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 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: �/ 7 t y E 1R O O` own,„� G oriTent ature Date (Revised 1/11/2019) Page 1-Application