1700 13TH ST 2020-08-28 - Laserfiche WebLink

t ` 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits ; PROJECT.SITE-INFORMATION PROJECT ADDRESS: i 4-00 i 14 '4- BUILDING AREA: sq ft PROJECT TYPE:yiNEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY #OF UNITS: COMMERCIAL ELECTRECAL.APPLLCATIQN"FNFQRMATI4N $ DESCRiRTICIN OFiKQI CONTRACT PRICE OF WORK:$ S2%C)-1`'11-1- ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 17-- w,•,...,5 Level 2.., ewt.p i)Le.a 0 i- I GC F2AJLtD I 50# cl if-�s , -4 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) ` LINE VOLTAGE WORK? 111 NO ❑YES-Select Scope: 111 Service CI Feeder Circuits-#: I ❑Complete Re-wire LOW VOLTAGE WORK? SAO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑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. El Other(List All): CODE-COMPLIANCE' IS THIS ERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: n NO .ETYES--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 S Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:RIO 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,.1NFORMATION OWNER NAME: Fre,t1 tCC. 45icmlCdf .' .c:-cti cCL( TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET y�(4,O I Gi,--a.Vvi ) 6''J •112)/0 CIN 1?- -il STATE It C�a ^J ZIP ii � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: JET 61kt�kti CONTRACTOR ADDRESS: STREET 5-6.,1 q 4-1' A0 5 CITY C1G' L- / �" STATE Ai* ZIP /G3 I V 6 CONTRACTOR PHONE:2.t.4,-"- j/,,- S LOC' CONTRACTOR EMAIL: V '12 E V 2 1 0 Q CONTRACTOR LIC.#(REQUIRED):UGGIt EC.a_Sl{2.I'kU CITY OF EVERETT BUSINESS LIC.#(REQUIRED) O -/9 f-!5- -PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR E )THER(Please Specify) F. C a &ctti1 at/ (-4471241 CONTACT NAME: f I CONTACT PHONE: 20 43 ,to j o ' 36 3/IS CIA SGYl t M1f.✓Tyl`/- CONTACT EMAIL: j ' .sci isu't. I L1I l%v.:7-e 4 . t,o•4', AGREEMENT::I hereby certify that 1 have read and ex mined 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 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#: r/Auth zA ent Signature Date,� T /i ,� E I0( Cl - 4.0 _ .„_,,,,,, caneed (Revised 1/11/2019) Page1-Application) e�f g