1202 GRAND AVE 2020-06-17 - Laserfiche WebLink

MAY-20-2019 13:22 FROM:STERLIN-. FLECTRIC 4254858E06 Tf1: 14252578857 P. 1/1 11 `; ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 05201 WASHINGTON (P)425-257-5310 I FAX 425-257-8357 I(E)everetteps©everettwa.gov I www,everettwa.9ov/pennhs PROJECT SITE 'INFORMATION PROJECT ADDRESS; I Z. G1 QA f t) ANE., BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT REMODEL BUILDING USE: XSFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ........ELfCTAiC#L APPLICATION INFORMATION &.DESCRIPTION OF'WORK . _ CONTRACT PRICE OF WORK:$ S 0 0— ASSOCIATED BUILDING PERMIT#(if applicable); DESCRIBE SCOPE OF WORK: MPQ4e,,,(2- POLE ! Cho c41`02 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System El 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: XNO n 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ►i 0 EYES-See Below&Pg.3 Li Pursuant to RCW 19.23.261, property owners and leaseholders cannot perform electrical work on •uildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption. E3y 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: TENANT BUSINESS NAME(If Commercial); OWNER MAILING ADDRESS: SIRE 57 CITY _ 3TATe YIP OWNER PHONE; OWNER EMAIL: CONTRACTOR NAME; s-raj2.Lu 4 - E.Lec i KJ C,, I i-I C. CONTRACTOR ADDRESS; STREET fe.1O.( 'z . /� -y�L7 CITY \i' 16)()t I.tY V i 1--.1— • STATE vif"� ZIP 9-� 01 .•, CONTRACTOR PHONE:LCYo ']93. 4.1G7— CONTRACTOR EMAIL: S r r aQ -S'-e {-j e.r C Q tryt CONTRACTOR LIC. REQUIRED : S L Q CITY OF EVERETT BUSINESS LIC. :REQUIRED I (� 5 PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Z 06, , • • • E- E ERCT CONTACT EMAIL: ..,MM O r.tl er, • V A REEMCNT:1 hereby codify that I have read and examined this application and know lfre Sema tv be t,ea air cv'(ocl. All 1x0v/5iun5 0 laws and onfineeroes yuvarninMa 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 provlrions of any other state or local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made end I comply with the State Contractors Law 15.27 RCW end 298,200 WAC. City of Everett Official Us*Only PERMIT#: `-.1 • Vz 9 E \,,c: 05 — 1(:) Owner/Authorized Ag• Signature Da� (Revised 1/11/2019) Page 1-Application