1202 GRAND AVE 2020-06-17 - Laserfiche WebLink

JUL-12-2019 09:18 FROM:STERLINjECTRIC 4254858606 T(�• 14252578857 P.1/1 III II OM in ELECTRICAL PERMIT APPLICATION CITY OF E_VERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT',WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everatteps@everettwa.gOv I www.everettwa.gov/permits -..:. ...... PROJECT SITE INFORMATION ... .. . .... PROJECT ADDRESS: 1 20 Z tCIIZ0t14.43 Q WJE BUILDING AREA: (0O0 tS1 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION la ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE; RI SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICA 1''IONANFORMAT ON A. DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ ^+ it. (Qitsc:fzb JASSOCIATED BUILDING PERMIT#Of applicable): DESCRIBE SCOPE OF WORK: ADD ATI-ACM.ETh C,117--tiR-n-I MASTI6iL STE A ‘/'E _ 1104E S 1 I c.E - Cs)4.IU -r Ex,sr!i1EK 1"4544EL- h S u 6f4141 ZOO ,Art? 9/1-1 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO E YES-Select Scope; Sevice Feeder g rCircuits-#:4- ❑ Complete Re-wire LOW VOLTAGE WORK? t�❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data? ❑Intercom ❑Thermostat ❑Audio 0 Secure Access © Security System 14.7r ,u.Zg r 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. i � ❑Other(List All): CODE COMPLIANCE IS THIS PERmiT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES-See Below&Pg.2 El By checking this box,I am stating that I have read and understand all of WAC 29646B-900,selected the specific reason on page 2 ef thls 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: NO =See Below&Pg.3 ::::1 Pursuant to RCW 19.28.281,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or loose without the propor°Ionics!licensing and certification,or exemption.By checking thls box, I am stating that I have completed and see page 3 signed the AFFIDAVIT on page 3 of this application to rec,eive an exemption from this licensing/Certification requirement. OWNER NAME: T23.6.141e3.- Le,,d.CA-t TENANT BUSINESS NAME(If Commercial : ---........ •• - .Ej 2.0Z GrizAgp Aire CITY r . rove ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME s-re .Lit ick- L Lg.Ch i ivy Iia L CONTRACTOR ADDRESS: 5TRgs-r RO F3Q- /k zq'�' ciTr Woo D Nom/1 u+e..." STATE VIA ZIP 9 OD 7_ CONTRACTOR PHONE:ZOIo•'3, • Z. CONTRACTOR EMAIL: Sfe.r I{p, re.ap 6-1.1.e.n.c.Dyn CONTRACTOR LIC.#(REQUIRED): s 2-L ET 095 KH CITY OF Eva,RErr BUSINESS LIC.#(REQUIRED) 0 S W10 PRIMARY CONTACT: DOWNER _&-tij:ONTRACTOR ['OTHER(Please Specify) � � CONTACT NAME: y� CONTACT PHONE: Sah1+ As (�+-i-�Ac.. � ,G.7'>' E) C.ic CONTACT EMAIL: It tr AGREEMENT I hereby certify that I have read anc'examined this appticafon a the same to be(rue and 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 twat lew 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 Slate Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only PERMIT#: 1- 1 z-►R E \WA —.10 °‘ Owner/Authorized Agent Signator DateRevised ( 1/11/2019) Page 1 ApplfeallOn