1205 CRAFTSMAN WAY SLIP 26 DOCK G 2021-12-06

Feb, 27. 2020 11 : 00AM UPS Store 1077, No. 5510 P. 1/3 1 ,Zi IN AL PERMIT APPLTION EVERETTCITY OF EVERETT PERMIT SERVICE 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 i FAX 425-257-8057 1(E)evercttepaleverettwa.gov I www.everettwa.gov/permil5 . • '• : r PROJECT , ATE INFt?RMATICS -�`".:- ''ii PROJECT ADDRESS: /id) C/o,Ili ill on U CL7 2.6r) [BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITII N El TE NT IMPROVMENT ® REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL `'.: ELECTRICAL.APPLleATIOI .INFORMATION,8: DESCRIPTIdN OF WORK 1 CONTRACT PRICE OF WORK:$$ & JASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: f L Chr/U , 14,t ;" l , �D� tilt, h�1t {\ �, � �ct,,,(e_ f i I e./ �1�s n 1 f4Ag ' S�l�s �I�# THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? CI NO I ".YES_Select Scope: Service ❑Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? rgNO ❑YES-#of Devices: I�t SELECT SCOPE (REQUIRED): El DataData ❑ 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): . • • 1 y,,,.a ` i, .,,,y, � :�� . ., �+`Q1y��f.;IQI�E"�:I,ANC�� . .�„�='` tj rR�' �� 5 IS THIS PIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES .` NO LJ YES-See Below& Pg_2 ERM ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46B-90 s lected the specIfIF reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub.ections that do not See Page 2 require Plan Review_ ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSUR=' '% •/Pg YES-See Below&Pg. 3 Pursuant to ROW 19,28.261, property owners and leaseholders cannot perform electrical work on at ifCline for r=nt,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 a signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. . ,1, 'C'ONTA0'1ANPORMAT10 '( ,.„, { 4 OWNER NAME: 174 q LJJJ.4 0(S o i.n TENANT BUSINESS NAM_E(If Commercial): OWNER MAILING ADDRESS: STREET /� I i61 I y/ t- '— �� CITY 4-IJt (�/kt' STATE Li p ZiP /U 7 OWNER PHONE: 2,6 J- y/�-9 yyy OWNER EMAIL: b/A✓I dbin(Jr 0Ic7]1/1 4,(;.ii al C. Cain CONTRACTOR NAME: CONTRACTOR ADDRESS: STR Er /) CITY N /1 STATE= ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: XOWNER ❑CONTRACTOR ['OTHER(Please Specify)- CONTACT NAME: CONTACT PHONE: �U b 7 /„ x-A v(r �faV(J(JI/1 B co CONTACT EMAIL: b(c n )(Jn Cr I Sp.t C ) , , Ter EMENY.-I hereby certify that/hava r&ad and examined this G G(� • C� elapplication and know(h®same to be hve an correct. Ail pre sions of laws and ordinances governing this type of work will be completed whether specified herein or not The granting Of 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 properly to perform the work for which application is made and I comply with llra State Contractors Law 18.27 RCW and 296.200 WAC_ City of Everett Official Use Only PERMIT#: '26/ Zn E 200 S - ek Owner/Au-the Agan gnature Date (Revised 1/11/2019) Page 1-Application