1816 WETMORE AVE 2020-06-15 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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 PROJECT SITE INFORMATION PROJECT ADDRESS: .) i Q Wim\W r ove, Avg BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: I ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION 84 DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ I 1 K ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Rp\Drake. .levi`I\ - MO`" 1 PDV'L\ ` tk-1fe.bI8Y`Y\ .C1tCV ` - uC Y\e he '1 \ bakNoo a- Liv1hnC'OOm) reA)Vc - e_ SkI ato \(\e zub THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO NI..YES-Select Scope:' Service 1❑ Feeder ' ] Circuits-#: ', ElComplete Re-wire LOW VOLTAGE WORK? ❑ NO iK1 YES-#of Devices: '--- 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: ❑ 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 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: INO ❑YES-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. • n CONTACT INFORMATION OWNER NAME: 1,x,,'1,,;,,,; •.... -�'V�W1\e\ TENANT BUSINESSPoe--. � � NAME(If Commercial): OWNER MAILING ADDRESS: STREET \et5\\(D � VUV� P e- ' \ 1 i , CITY /��ive V STATE w(y ZIP \ OWNER PHONE: 1��-!- L2 13 OWNER EMAIL: i,eC-\V ��(.-v` \oW3 c k.A\c 1� LL CONTRACTOR NAME: CG CONTRACTOR ADDRESS: STREET ry 0 0.4 :'► V,c9 V ;.,1` 2,5W)- ' SE tGlA\r '-t-, CITY 1 . STATE ZIP 0i0,9\, ‘, I )2_/ • CONTRACTOR PHONE:7O10 (S-t3 �2 CONTRACTOR EMAIL: 14 v' v` f\e_ek O\` NA"' O1 UIRED: clef_ �- CITY OF EVERETT LIC.#(REQUIRED): 7 CONTRACTOR LIC #(REQ ) G1P� .1 Z � : .. .. Ir PRIMARY CONTACT: 'OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2M? t!J"1 — (p -� �1(I ` /�`/� ' �} 1 +1eC\ )3 CONTACT EMAIL: -pied �`l..C8,CNd1��G4`v\(( 0\v oV1S A4 AGREEMENT:I hereby certify that I ha a read and examined this application and know thS same to be tru 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 th State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: A. E `-10LE ' .A.c- Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application