8910 4TH PL SE 2020-08-27 - Laserfiche WebLink

mi ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits s PROJECT SITE INFORMATION PROJECT ADDRESS: j 10 4 l L S BUILDING AREA: 1 —/ .1 6 sq ft PROJECT TYPE: ❑ N W CONSTRUCTION Lid ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: D6FR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK 71 CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): Al (q/O-70 /UO DESCRIBE SCOPE OF WORK: c�, Actv,.�f jA10 mtnI ,,ptit y449,1 f Int) / P1 s yscile-\ 400. THIS INSTALLATION INCLUDES /THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? IJf O El YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? LI NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional lt Fire Alarm Permit is required for review of device location and irWst�,a,,tion approval. (c,,k,�\CI1 Irl � t I J Other(List All): /}AiI iAiy' c i 1;V'It6 k \ ( -k e Xt>h1() yct I IAA /.tii c 4,PO i A'41tr CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO El 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: ENO YES-See Below&Pg.3 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings or 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. CONTACTINFORMATION OWNER NAME: F tI\. 4(7(f\ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS:+ STREET { 0 `) I�O /�1 t� t 7! }^ J CITY Y vQ{Q V-1-- A STATE V i PI zip 9 t r 0g OWNER PHONE: OWNER EMAIL: n i1()0.9I 0 A-ut C l`1'Ylt 11 011e CONTRACTOR NAME: G)W I'�7 CONTRACTOR ADDRESS: STREET ( CITY /7 STATE rr ZIP ,./,, CONTRACTOR PHONE: j17_ •6 3 ,'( AOC)CONTRACTOR EMAIL: GJ t.t1(11(w e 1Ii✓l CLQ 1D (/ CONTRACTOR LIC #(REQUIRED) ?,//A CITY OF EVERE•r BUSINESS LIC.#( ) Ai/A Lvvl PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) Z CONTACT NAME: CONTACT PHONE: 7 1 L — 6 3.7 'ud )7 \-tva CONTACT EMAIL: i illvA j,llle►x. (AWE 1'110ii;Car AGREEMENT:I he eby certify that I have read and examined this application and know the safne to oa rr a and correct. All provistbns 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 work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 1 \di ki 9E q ( 6 — u Sc5 ��I 311 Owner/Authorized Agent Signature Date (Revised 1/11/2019) /gage application