10812 19TH AVE SE 2021-02-23 - Laserfiche WebLink

• INN `; ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everettev,@everettwa.gov I www.everettwa.gov/permits P .1ECT>$ITE INFORRMATION PROJECT ADDRESS /I Ake. c BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION IgTENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI FAMILY #OF UNITS: [COMMERCIAL ELECTRICAL:APPLICATION_INFORMATION,&.;DESCRIPTION,OF WORK CONTRACT PRICE OF WORK:$ ' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: t ` Lip r-t * THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO 0 YES-Select Scope:❑Service ❑Feeder Circuits-#:Z 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ 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. 0 Other(List All): g.:'r, a``, S'i:`, ; „k ,,:' ,..`:,i CORE gCOMPLiANCE` _...,`. ".;, IS THIS P RMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO 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 A OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: lNO OYES-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: 00.Q4,.'' Lze.- TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET I0St i ire. fe. CITY eA c STATE Y •" zIPg9.2-0P OWNER PHONE: (4 -- )') L'1.00 OWNER EMAIL: CONTRACTOR NAME: eV eA,1 r eeel t5 I f� U k &AQ) (A)CONTRACTOR ADDRESS: STREET u l ...0 GIG ft c_ Y N e.,,ccm, Ev P re-I — STATE ` ZIP 43 FhhZV CONTRACTOR PHONE:cfuj-2.1 2.^'5I(a CONTRACTOR EMAIL: GlielQ'r 1 SS-C.Ld e s SSW C ., CONTRACTOR LIC.#(REQUIRED EVE R-EISS 92.81z,IJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 001 SS PRIMARY CONTACT: DOWNER ►' ONTRACTOR ❑OTHER(Please Specify) CO T CT NAME: p CONTACT PHONE: I-11_Gj 2„�j'L, 3 ) i 4J (� ( J JL 01(ILAt e,(S CONTACT EMAIL: Ckay-i SS2 esss yY)w Q (_.cf YV� 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 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 lam 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 1 PERMIT#: A01AA' V zI i E QDO 21 I wner/Authorize Agent Signature Date (Revised 1/11/2019) Page 1-Application