3412 NASSAU ST 2021-01-04 - Laserfiche WebLink

MN • IX ESE CTRICAL PERMIT APPLICATION �[ Y�r[� I ICITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 wtt atiNcsroci (P)425>257-8810 I FAX 425-257485577 I•(E)everettepst��everettwa:gavI Wu+weverettwa.9gvtpermtt PROJECT ADDRESS:' fir, I '�IMIl,BUILDING AREA: sq ft PROJECT TYPE: ❑ WCONSTRUCTION 0 ADDITION ION Q TENANT IMP tOVMENt 0 REMODEL BUILDING USE: 17 SFR 0 TOWNHOUSE C3 DUPLEX El ADU 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL . o 4 } CONTRACT PRICE OF WORK:$3 � ASSOCIATED BUILDING PERMIT#Of applicable); DESCRIBE SCOPE OF WORK: < s.‘' 0 ea cg) r' a, , kt, _ .4 , _ 1-) -i--, x. vkA THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:'6].Service 0 Feeder ispCircuits-#. , E Complete Re-wire LOW VOLTAGE WORK? it.., r 0 YES-#of Devices: SELECT SCOPE(REQUIRED) 0 Data 0 Intercom 0 Thermostat In Audio El Secure Access ❑Security System: 0 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 1.1 NO III YES—See Below&Pg.2 DBy checking this box,1 am stating that I have read and understand all of%VAC,296�-46B-900 selected the speci#ic 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:JNO LIl'ES-See Below.&Pg.3 _ Pursuant to ROW 1918261,property owners and leaseholders cannot perform electrical work on bu dings for rent,sale,or lease without the proper electrical licensing and ce tification,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. 5:, OWNER NAME: t TENANT BUSINESS E(If Commercial): :OWNER MAILING ADDRESS: STREET V. E CITY c"-Akslt STATE ks.k5Y4 ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: rr ., ik,..) t 'CONTRACTOR ADDRESS: STREET [ CITY VATS PIP Lp CONTRACTOR PHONE:lfi `"" -b. CONTRACTOR EMAIL: r qttetcall CONTRACTOR LIC.#(REQUIRED): , Q A- CITY 0 EVERETT BUSI ESS LIC,#(REEQUIRED): n I PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CO TACT NAME: CONTACT PHONE: il 0— s �^, �n I i p .J. ,# CQNTACT EMAIL: t l� t1.,AGR l EW:t, rreby cart' that I have teed and examined this application and know the and . All ro flaw.s and orainances,•.ve type of work will be completed whether specified herein or not. The granting of a permit does of presume to give"autharky to violate or cancel the provisions of any other a e or local law regulating construction or the,performance of canst vc1!an, That I am authorized by the owner of this property to perform*tier •work for which appiioatltort is ra de and l comply the State Contractors Law 01.27 RCW and 286.200 WAG. City of Everett:ffMotelUse Only ' 1— J‘ ( il.c-A \,6,' ).0 ti, PERMIT#: 'q Own u orixed Agent natu Date a 9 (Revised 1/11/2019) Page 1-Application