3623 HOYT AVE 1-3 2020-06-17 - Laserfiche WebLink

ELECTRICAL PERP aT APPLOC ° u IION ;r, CITY OF EVERETT PERMIT SERVICES c,•-"%•••1 ,_ �✓ yZ� 3200 CEDAR STREET,EVERETT,WA 98201 t/d (P)425-257-8810 FAX 425-257-8857 8857 (E)everetteps@everettwa.gov I v ow.everettwa.g____ _-- -^- J `>�/j 1 /f� 1.e__ �7�� 1 f BUILDING AREA: I /2 C Csq ft PROJECT ADDRESS: '-,C,- �� L I � JTl PROJECT TYPE: I NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL ❑ COMMERCIAL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: LECTRECA APPLIIGEFEGE1 arafoR Allo &. DEZeittPTEONI GP' ©-E CONTRACT PRICE OF WORK:$ r Ael 0/0 ASSOCIATED BUILDING PERMIT#(if applicable): --I ) 7 �C-7 7-' "DESCRIBE SCOPE OF WORK: ire_ AICs f !THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? -U-NO 0 YES-Select Scope: U Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO Ki Y-ES-#of Devices: :4- SELECT - SELECI SCOPE(REQUIRED) © Data 0 Intercom D 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. 0 Other(List All): CODE COME-'--LEAkICE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH A _ ■ � YES--See Below&Pg.2 � ND/OR PERSONAL CARE FACILITIES: NO 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: 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 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 I ORMAT W M_ N TENANT BUSINESS NAME(If Commercial): OWNER NAME .‘ ; eci U1Ar) a OWNER MAILING ADDRESS: STREET / 5- 2_2,(p ,2(--17q4 CITY i/17141 YJri/-4 � STATE LA)/r ZIPrP08 OWNER PHONE:57;-( OWNER EMAIL 'L r4 I Y ��1C c-1 TA l'C ,'''(*lC ti‘l( 14 5 C t/t/l Ee( '1 i�'ca '50/ JI(;VI5 L L CONTRACTOR NAME:CO S 2'G<c��l( lI � CONTRACTOR ADDRESS: STREET /Tj� ,,,,z �.� 70 P'CITY l�� — ��p /l �06(� STATE ZIP O CONTRACTOR PHONE: �6;d Cy e 2"Y? itONTRACTOR EMAIL: I1^4 e.0 CG 5CCedl 50/1A f 100 J. CO .. r , CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (CONTRACTOR LIC.#(REQUIRED) 6 _ �' • � PRIMARY CONTACT: 0 OWNER .C.._.. RA E�CONTRACTOR 0 OTHER(Please Specify) // CONTACT PHONE: 5 �Q _ it /� ! (CONTACT NAME: , CONTACT EMAIL: � 2 1(�'p 1 'cc-��C'� i I C L1 J t CO L L; C'L:i b� -Dr-,V;1 �an�( AGREEMENT:I hereby certify that I have read and e�tamined 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 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 construction or the performance of construction. That I am authorized by the owner of this property to perform the wty for r which hrett Opic licaati ion Use made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Ci1pERM IT#: ^ C1 E ��o3 ---O O „ — �_��,� Revised 1/11/2019) Page 1-Application iwner/Author '•.ge""Signature Date