Laserfiche WebLink
0 WW2 <br /> ELECTRICAL PERMIT APPLIC TION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 wvvw.everettwa.gov/permits <br /> r/ /7„/ /// AT77457 isr;7777777:74Tre/Trce <br /> PROJECT ADDRESS: CN,i -j w, Lt. BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT REMODEL <br /> BUILDING USE: 9SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> CONTRACT PRICE OF WORK:$ so ASSOCIATED BUILDING PERMIT#(if applicable): 1' ► 1 Op <br /> DESCRIBE SCOPE OF WORK: <br /> S C 9 (4 vc",P A d (4 v A 6- <br /> THIS <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO YES-Select Scope: ❑ Service ❑ Feeder (K Circuits-#: ( ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System <br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> /Z"'Y/'/ 747/1774;127177171T7 <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ill'NO U YES--See Below&Pg.2 <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: LNO EYES-See Below&Pg. 3 <br /> ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease <br /> without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> OWNER NAME: c p �-t L l C TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET nZLI 33 I,/ 7442W <br /> CITY �1 STATE W/t ZIP 3 <br /> OWNER PHONE: Lin: 31(7. .�7�1 OWNER EMAIL: <br /> CONTRACTOR NAME: L i'vu t <br /> CONTRACTOR ADDRESS: STREET 7� ( �j <br /> CITY � !✓V( -'(/t STATE L ,e '-- ZIP FPGJ�- <br /> CONTRACTOR PHONE: LOS-- ff ey„c•,, ,7 S1 CONTRACTOR EMAIL: 4(f 4' ,64(v <br /> CONTRACTOR LIC.#(REQUIRED): iiV�?L�T'f Zc>V CITY OF EVERETT BUSINESS LIC.#(REQUIRED): r✓( 07oq <br /> PRIMARY CONTACT: DOWNER .CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> el/64V— CONTACT EMAIL: <br /> AGREEMENT.-I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Ci of Everett Official Use Only <br /> PERMIT#: <br /> (4;(2._((( E g 000 <br /> Owner/Authorized Aignature Date (Revised 1/11/2019) Page 1-Application <br /> 3 <br />