6623 HIGHLAND DR 2020-06-17 - Laserfiche WebLink

ELECTRICAL PERMIT APPL TION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERET t,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@everettwa.gov i www.everettwa.govipermils PROJECT SITE INFORMATION , PROJECT ADDRESS: 6623 HIGHLAND DR EVERETT 98203 JBUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑REMODEL BUILDING USE: SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATtOttADESCRIPTION OF'WORK, CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: RELOCATE RECEPTACLE AND SWITCH IN MASTER BATH. INSTALL CUT-IN BOXES AND LIGHTS C ON EXTERIOR OF HOUSE. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope:0 Service ❑Feeder 2 Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO 0 YES-#of Devices. SELECT SCOPE(REQUIRED): El Data ❑ Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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. 0 Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO ❑YES—See Below&Pg.2 (�I 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 I f 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. ft�1y ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO 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 l 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. CONTACT INFORMATION OWNER NAME: ROB GRIFFIN TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTaeeT 6623 HIGHLAND DR cm, EVERETT STATE WA zie 98203 OWNER PHONE:NA IOWNER EMAIL:NA. CONTRACTOR NAME: in house electric CONTRACTOR ADDRESS: STREET 1530 117th dr se crr lake stevens STATE wa zrp 98258 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:ihepetTnitsiC�7�gmaiI.COITi CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 kelsey CONTACT EMAIL:ihepermits@gmaif.com AGREEMENT:I hereby certify that I ha read an. :xamined this application and know the same to be true and correct, All provisions of laws and ordinances governing this type of work will be completed whethe specified he .in 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 regulatin.contra :on or f performance.1 construction. That l am authorized by the owner of this property to perform the work for which application is made end 1 comply with :Ste'Co•. am o w 18.27 R ' jr,296.200 AC. City of Everett Official Use Only PERMIT#: / 7(z5�'�q E Owner/Author zed Agent Si-ature Date 11 (Revised 1/11 019 9 ( ev ed 12 ) Page 1-Application A ...:4 L. f+