2904 17TH ST 2020-08-28 - Laserfiche WebLink

• ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everettepsreverottwa.gov I www.everettwa.gov/permits . . .. i i :iaGI A : 4atil .:F u- I• J ry 1 i '" y s7u v . : . ,� }...i,f�.,1.�.+� .�-. +lt.)l'.:J1 ii C°.11•>s;�� :'��w`�4+T+'�a��.��-.�'>>�r�Js�f,',�, r, -.a -� _ PROJECT ADDRESS: 2904 17th St. BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 0 REMODEL BUILDING USE: 1=1SFR ❑ TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL l: rJhet ,l t i l sr p .0 CONTRACT PRICE OF WORK:$ 6000 r lr /.+ F ...,.v,� `... f 1, <' F �.I .: R! +7 L ,r+�.,�,� «� <. ` s tp "... ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 200 amp Main Breaker Panel Install 100 amp Sub Panel THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope: El Service ❑Feeder Q Circuits-#: 4 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO Cl YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data El 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. ❑Other(List All): t tx '3 ; Yf 1VFa `� _t. J.{J gZid-i , Fa + 1arai:; Y rIS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES--See Below&Pg.2 I 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 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 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. rit it f� J Mag -t ��.:,r'� ✓-•�l` :� .c�'..a�f. "U �'.. �� .5trcA -.S �. kr.-s#..r w �Js,� ° .-t�_I>.�.-i_ .6. y�J(. ,I-fi�',)',t�,E�'°�^. � �F� •E,'ail �'F��3r �T'sA��E�-� f_5 a4�'�, R 3.F:,Z,-<f�'ry+�i I.l�'.•xa,„dt OWNER NAME: Victoria Jonas TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2904 17th St. ^ , Everett STATE V��/A „P 98201 OWNER PHONE: 602-571-0177 OWNER EMAIL: CONTRACTOR NAME: Parker Bros Electric CONTRACTOR ADDRESS: STREET 13630 54th Dr NE c,n Marysville STATE vvSAI A Zip 98271 CONTRACTOR PHONE: 425-239-6319 CONTRACTOR EMAIL: Bary@parkerbroselectric.com CONTRACTOR LIC.#(REQUIRED): PARKEBE845NT CITY OF EVERETT BUSINESS LIC.#(REQUIRED);69319HM0918 ❑ TRCTOR ✓❑OTHER(Please Specify) Natalie for payment and Info PRIMARY CONTACT: CI OWNER JCONA tt CONTACT NAME: CONTACT PHONE:360-572-0108 Natalie CONTACT EMAIL: admin@parkerbroselectric.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ail 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 286.200 WA C. City of Everett Official Use Only PERMIT#: U 4/15/2019 E I o " l" op Owner/Authoritl'e Agent Signature Date (Revised 1/11/2019) Page 1-Application