2204 12TH ST 2020-08-28 - Laserfiche WebLink

L CTRICAL PERMIT APPLILJITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ,. ;)(- =-( - i a i-h 94_re, 4- BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK `, CONTRACT PRICE OF WORK:$ oRCt--,, 00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Re 0Lc'c e © Lc) "t'�,I S4ECA.f-Y\ n L ',,,J i-� v '') " k; - k c � C1 �P C\ L. ► y^ t ' ) /L\C'.:.,\ � ^--e_CL"A `�C.b I_L.^ .`70_YYl Lam'_ �7� r. 57-4..•a.Lt._i LAK.- (AI Alkok lies THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SE A L THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Sco.-': • Service ❑ Feeder ®Circuits-#: <...-----.-7 Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of De/'ces: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom • Therrtjstat-----E"Audio ❑ Secure Access El 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. ❑ Other(List All): 9/.41( t CODE COMPLIANCE ' /_ / j IS TI-IS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACIL IES• !.;14J>• �� S--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296 13.90 I'`/lecte• the '•ecific son on page 2 of this application(see next page),AND Plan Review is NOT required because I mee wifig-sub sections that do not See Pa e 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®NO EYES-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 INFORMATION OWNER NAME: ! rc.r-v__ C'�,v-,--"';(--,v /. TENANT BUSINESS NAME(If Commercial):, OWNER MAILING ADDRESS: STREET ,-. .;.) C L-1- ` Q t41 c� i- CITY ElJe-In6) -- STATE Lam)A. ZIP 96,2 c/ OWNER PHONE: OWNER EMAIL: C1oy-c-i(7)\/Com,❑/6(--- 1'. (c I"Y1C C< I--; AJC.:_- CONTRACTOR NAME: fr e, E.L C r( C CONTRACTOR ADDRESS: STREET I SC ( S - "e Co Atie , CO, 64_); ` - H CITY LL ALA i W(-)r-)a STATE wA ZIP 98 036 CONTRACTOR PHONE:tila 5`7 74-7(7QO 'CONTRACTOR EMAIL:Mre.LC'r Tir/Ic p{1 y- - e—SEn1_€c, cj,vr ;L Co m CONTRACTOR LIC.#(REQUIRED): 'NVIR.. LCG.6 890 R C,CITY OF EVERETT BUSINESS LIC.#(REQUIRED):e6-7S i 6 PRIMARY CONTACT: 17 OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: A.Q6 - 77// 7 �, IL': (-2 ��/ ' A, /2 sS CONTACT EMAIL: p/tv,l_F'C�6,i C_,„ y Tt`' ,4 Lt; C.t l i">)c t,cc m(-Ci. r�,�(G � AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. .11 provisions of laws and ordinances fjo eming 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 compl with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Wa f o E nv) .___. CI Ow er/Au orize gent ignature Dai (Revised 1/11/2019) Page 1-Application n C.1 - ' S:S