821 W CASINO RD HAND IN HAND 2020-05-05

LI E :CTRICAL, PERMIT APPL \TION EVERETT CITY OF EVERETT PERMIT SERVICES 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 I PROJECT SITE INFORMATION PROJECT ADDRESS: cacl I W CAM) ea BUILDING AREA: sq ft PROJECT TYPE: Ll NEW CONSTRUCTION ❑ ADDITION El TENANT IMPROVMENT 1=1 REMODEL BUILDING USE: g SFR ❑ TOWNHOUSE ❑ DUPLEX ADU ] MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ LJOQ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Q_2Wl re 17.:11-orte,ri , dd y lw - , .�YNY , andbG t4roo� . IU U V t i 5C1Yc,Utt''I • aeplAC,e kweGt.k-eX.S I,Y1 pcucte-I ; (Lv✓t lave v0it- to -t-Df, �HOOY 0Jp(i(_e ') • fon •off 'Por INII.ntSt9tAt'S , re,9101-01- GW DoiU-tS b 61A1 utc)A-LS, re,Yvtovk, u.11 0.1.d-rit, t).1 al Yv.c cr,S THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 15/YES I -Select Scope:P Service ❑ Feeder RI Circuits-#: `J ❑ Complete Re-wire LOW VOLTAGE WORK? ElLC�- NO YES-#of Devices: gj SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 13 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 tha 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: ONO 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: Ti)Ltd M c Neal. 1 -and L4') tivild TENANT BUSINESS NAME (If Commercial): OWNER.MAILING ADDRESS: STREET Qj1l V\.V\. (.c4 't 11,0 4• ¢ �{ CITY vei,�e STATE W A ZIP 61 5 ` OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 31UC Y-ta n.c. 1}CI.4I11,1 .5 Lite CONTRACTOR ADDRESS: STREET a'�WV1ill tJ I,Z _o 52 — 1A.1 ` 1 1_ kA... (� CITY 1 1vw-C, Te aCL STATE wi g 1 ZIP -1270LG CONTRACTOR PHONE: (426,111• 11 .69 CONTRACTOR EMAIL: flfo Q 1c21UZ tank\. coW1-1FoY--t.corp CONTRACTOR LIC.#(REQUIRED): bl.0 C r-ir I$`3 l CITY OF EVERETT BUSINESS LIC.#(REQUIRED): t60L1 PRIMARY CONTACT: ❑OWNER PCONTRACTOR ]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: N2.5 1i 1 ii '),01L�ht`aE �a1� CONTACT EMAIL: t,,ne--0 (, 1otte ->=-1ame comfut.CAW) 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#: -7'B. 1,1 E iq 61 - m5 1 Owner/AuthorizedUAgent Signature Date (Revised 1/11/2019) Page 1-Application