11610 EVERGREEN WAY 2020-12-31 - Laserfiche WebLink

lc rC ECTRICAL PERMIT APPLIPATION 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 PROJECT SITE INFORMATION PROJECT ADDRESS:( ,y,-, II / j -�❑6ewr5 reap, ��c-` BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION CI ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE El DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: — COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $,k-j/L ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: repo(rQ i cam-{ i-rb 5 o Ji.-Q S 15ns., :`I- ,_.__ THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 111 NO ❑YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat Cl Audio LI 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: F 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-90 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: I!4 O DYES-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: ?LV)(la Cic pre-Ss TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET ' ` f ln,,.\ -ea if)Vt_ CITY STATE 0 - 71P �/./ 7 1( ' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:---Ile �(Sn . , ' (-)� CONTRACTOR ADDRESS: STREET a DI t G!KerJ, -C3 a cnY 1Z-t( (NC Y J rIc STATE / . .f\- ZIP(96 i; CONTRACTOR PHONE: "-(7i,6 � 4-4 V CONTRACTOR EMAIL: ( n' ' -"_S- z,n 1-, CONTRACTOR LIC.#(REQUIRED):SKI`bT / cJ2 Q (C CITY OF EVERETT BUSINESS LIC.#(REQUIRED):OS)9 e j) PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ` , CONTACT PHONE: 31at> - 60,-7� iL� -,I�L./3 n,� C.i 1 v 'V CONTACT EMAIL: Lc),ere CD 4'fll . —S;(,t0 ct f CX AG ENT.•/hereby certify that/have read and examined this application and know the same to be true and correct. All provisio o law 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 1 so comply the S-e Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: t,i:kin,CIL ai k. 2 6- ao E 2 t-c r7n"I t .nze.Agent SiglattIre rate (Revised 1/11/2019) Page 1-Application