4805 BAYVIEW LN 2020-06-16 - Laserfiche WebLink

r ELECTRICAL r'E r.Th MIT APPLICATION CITY OF EVERETT PERMIT SERVICES 4.40" _ _r 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits //�� PRO JECT SITE INFORM ATION ', �-1 PROJECT ADDRESS: ,�a y F7c,. ( J'e� �.>"� 'BUILDING AREA. 3 I 51 sq ft PROJECT TYPE: ! I NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT 0 REMODEL BUILDING USE: I1 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION:INFORMATION:&:DESCRIPTION.OF WOR CONTRACT PRICE OF WORK:$ &‘..";00 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: lA)i re..- n-ZX^-! Cc.•��r'vc.lrtO( fG`N (' Zoo 417 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 161YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): * Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 Security System 0 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:COIVMPLIANCE'_ '; IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ® NO 0 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: IAN° OYES-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. :CONNTACT INFORMATION, OWNER NAME:��,IJ�G.. VfJ Aj TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4 Uo &AA vd /A^/ Il f�4.,v A' CITY STATE ZIP IgZ�3 OWNER PHONE:lis 3 .5� /oe 3 'OWNER EMAIL CONTRACTOR NAME: AIf5L IN E 1 tali(---- CONTRACTOR ADDRESS: STREET IL 3a 3 j a rdc/l Lk7 41^111111)I ZIP / f-z-z_-'5 CITY / STATE CONTRACTOR PHONE: SLS ZE 85$1:1/p CONTRACTOR EMAIL: S'�v1! (1f-p At—kr7 i L CONTRACTOR LIC.#(REQUIRED) f-1,5 FI e E �J'� 0 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED) TJ 5 i 133 PRIMARY CONTACT: 0 OWNER IqCONTRACTOR 0 OTHER(Please Specify) CONTACT NAM : CONTACT PHONE: Altc -2G j 3- 7 cf.,\, i CONTACT EMAIL: 0,t/ ti-,erre le t-ClrI C14 ,f/ , ("011/1 AGREEMENT:1 hereby certi that I have read and examined this application and know the same to be true and correct. All provisions o1TJ9aws 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 structi n o e rformance of construction. That I am authorized by the owner of this property to perform the work r for r which applicatt Op c atil n s mais de e and I comply with t tat ontr to a 18.27 RCW and 296.200 WAC. PERMIT#: 03Date 2'� 20(cI E 1(10 3 - ( 1 Owner/Authorized gent Signature (Revised 1/11/2019) Page 1-Application x(809 -- 004