2125 COLBY AVE 2021-02-22 - Laserfiche WebLink

_ . • ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTQN (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT;SITE'INFORMATION .- PROJECT ADDRESS: 2-' A Col Ai BUILDING AREA: 4o APO sq ft PROJECT TYPE: ID NEW CONSTRUCTIOn' ❑ADDITION LJ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: CISFR CITOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ®COMMERCIAL ELECTRICAL APPLICATION INFORMATION �&DESC:RItPTION'O `1l ORK CONTRACT PRICE OF WORK:$ �- 000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: /�f /,{��f 2 LJ 6ji fiL4'I4'S /+-G%7 , . G%/(i7 , ou7ze_ G/� 74o /0G /�E' ✓lA�.c4. ' / e /`cp 1p,ee- s�'�4ef aq d/is. THIS INSTALLATION INCLUDES THE FOLL. SCOPE: (SELECT ALL THAT APPLY). LINE VOLTAGE WORK? ❑ NO IgYES-Select Scope: ❑ Service El Feeder t Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat Audio El 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„COMPLIfANCE ,�+� IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: MINO U YES--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 See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: I JNO 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. :,CON TACT INFORMATION , ", ... ,. OWNER NAME:If-FA L(2- r CLOP_ .04 6ce Ia U S NAME(If Cymmercial): OWNER MAILING ADDRESS: STREET 2 I z 5— 6 ' /S /f Ve— CITY j- i A2- STATE (A ' ZIP y %0 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: f//rio,q tiv,fire CONTRACTOR ADDRESS: STREET /2y/q #&%G(/a, 9'9 STLc 2'O '�,by. eaege, CITY p / / STATE aik ZIP 9f ZV CONTRACTOR PHONE: y2�gee7�7 3Jv'OCOONTRACTOR EMAIL: part Gf qo(I19t/ � dNf/Od/. �/y CONTRACTOR LIC.#(REQUIRED): L!//€D EL c ' C CITY OF EVERETT/ BUSINESS LIC #(REQUIRED) N, L4 ' r PRIMARY CONTACT: DOWNER Tr.-CONTRACTOR ❑OTHER(Please Specify) �� )1 CONTACT NAME: CONTACT PHONE: y2.5-- 777 3,f?7 VikkACONTACT EMAIL: y4- , d 4o�/ 7 o� /001. Coo' ! I AGREEMENT:I hereby certify that I have read and examined this application and know the same to b 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#: dal( 6;44( Ii®��Z11/9 E � j \ ' 0 1 (6 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application 9 9 _..