Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> (477- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:? -V\ b. Yc'(ee-v\ VX13�y o/ A BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION 0,-TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> ELECTRICAL APPLICATION;INFORMATION&;DESCRIPTION.OF:WORK ._ <br /> CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: ‘a ( VA I an k..)<X-V( �k( <br /> a C (1) aWC <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 Security System <br /> Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> 0 Other(List All): <br /> `. CODE;COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: al-NO 0 YES See Below&Pg.2 <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:F NO OYES-See Below&Pg.3 <br /> Pursuant to RCW 19.28,261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box,I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> :CONTACT INFORMATION: ,,.,... . <br /> OWNER NAME . TENANT BUSINESS NAME(If Commercial) c t 1E p �t e <br /> OWNER MAILING ADDRESS: STREET 9M1 <br /> CITY ��( J STATE`l\A ZIP C �\Jg <br /> OWNER PHONE: OWNER EMAIL: <br /> ` ' 1 <br /> CONTRACTOR NAME:7>TIV PX. 61( C.) <br /> CONTRACTOR ADDRESS: STREET 6a---)C <br /> CITY\ STATE \1\- •' ZIP gqt0* <br /> CONTRACTOR PHON *2 )N..6- -RA'CONTRACTOR.EMAIL:' �(C}rVe, `(C - ft k' c \U1 C - r <br /> CONTRACTOR LIC.#(REQUIRED] ✓�� �,22RA9 .., .. CITY OF EVERETT BUSINESS LIC.#(REQUIRED):#T1$ <br /> PRIMARY CONTACT: El OWNER El CONTRACTOR OTHER(Please Specify 1. b`I� :I =�A� �' At <br /> CONTACT NAME: CONTACT PHONE: a0) W1,– -(p <br /> CONTACT EMAIL: CLt1 tyn(r('IU(`,1�((M`C,Q)tr _avl lOM <br /> AGREEMENT.'I hereby certify that I h e read and examined this application and know the same t be'free and correct-All provisions of laws and ordinance governing this <br /> 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 <br /> local law regulating construction or the performance of construction. That f am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> "max` d A e V` �� ��1� (Revised 1/11/2019) Page 1-Application <br /> Owner/Authored Age Signature ate 9 pp <br />