8417 EVERGREEN WAY PANDA EXPRESS 2022-05-23

ELECTRICAL PERMIT APPLICATION � �� CITY OF EVERETi PERMIT SERVICES h 3 y.-. 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govipermits PROJECT ADDRESS: sci 1 v" 2t%aR •1.i>hx` --§g ' _BUILDING AREA: G,3 sq ft PROJECT TYPE: 1`6' NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE n DUPLEX ❑ADU El MULTI FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL ''::..14:411.1::1.,x ': ,,,4 ti ,.; CONTRACT PRICE OF WORK:$ % ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF Y~O~~WORK: J P'_l )2 'v,2 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO VYES-Select Scope:Seivice El Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio El 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: U NO ❑YES--See Below&Pg.2 — By checking this box, I am stating that I have read and understand all of WAC 296-468-900,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. T ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑ E NO 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. F....:'.•. „G,rr i_ .a�aa��rs, +ks...>•.>,K5 k:. °� ., aa `•: r".. ; I: .tn�'.ONAI . 3; ARY::!'"f �'�•'hg ..,'kms a OWNER NAME: e Y �t j I„� TENANT BUSINESS NAME(If Commercial): i_mw ,, r 54e OWNER MAILING ADDRESS: STREET i(f)S3 ert A CITY ~1< _�.4.\("y STATE l .L1 ZIP „'®'j OWNER PHONE ` ' ( � OWNER EMAILf (? l CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET-7r) '6t> 3( , CITY ,t�t„-it-.. f\�� STATE I- ZIP CPR� CONTRACTOR PHONE t-'{ "i4 C CONTRACTOR EMAIL: a)Occc Ke-Gid bCrAt4,Q F I a C” rit'` -- C ,CoAil CONTRACTOR LIC.#(REQUIRED) L'� K g CITY OF EVERETT BUSINESS LIC #(REQUIRED): 5 e 5 PRIMARY CONTACT: DOWNER .CONTRACTOR ❑OTHER(Please Specify) w A_. „� , asSpecify) CONTACT NAME: ttfi.t.. CONTACT PHONE: 21,240 CONTACT EMAIL: ° i r"CA i Ck 4ic.w i CirI c_x is AGREEMENT t 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 wori<will bo completed'whether specified herein or not. The greeting of.a permit does not prosume to cava authority to vialafo or cancel the prnvisinns of any othercfatc 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 ROW and 286.200 WAC. City of Everett Official Use Only PERMIT#: Owner/Authorize Agent Signature Date (Revised 1/11/2019) Page 1-Application