3302 MCDOUGALL AVE SNO VALLEY PROCESS SOLUTIONS 2021-03-31

' 0 • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES Ork-77 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION. PROJECT ADDRESS: ; 7JDL MChr)UqCl\ AVP . BUILDING AREA: sq ft PROJECT TYPE: xl NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE 0 DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: 14 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK . CONTRACT PRICE OF WORK:$ CO — ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: y. D\Do( m , \Qi-jc\\� q CO c\ v\t Q> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO ❑YES-Select Scope: ❑Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO RYES-#of Devices: (q SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom ❑Thermostat ❑Audio 0 Secure Access 0 Security System 9eFire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Alarm Permit Is required for review of device location and installation approval. ❑Other(List All): `::ICODE:COMPLNANCE . �. , IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 14 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 AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:1INO 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. r C . ., ,OIdTpCT: IN�ORIYMATION , ,_ . ; ..;;: OWNER NAME: TENANT BUSINESS NAME(If Commercial):AM\JC\k\EYn(fj-SJ OWNER MAILING ADDRESS: STREET R '/ 5- E PA CITY �j\1;'` -\ �g STATE ZIP C' 2f)1 Z5) - '\ OWNER EMAIL: e�1)0uf�C Z\Ks(\kC�VC�E:�•�-Qk OWNER PHON �.�� v. .... . . � _ ... _. .. __ CONTRACTOR NAME: 5,0 V(Cl(Ak,N"41%1,0,V Octilv n )vY i") CONTRACTOR ADDRESS: STREET ` .* ) \ --Ci Q•"5 CITY DCRU � STATEE OR ZIP q�\7 4/ CONTRACTOR PHON )( ' �Jri� CONTRACTOR EMAIL:rJl�1141, �,�in.Q)tiatlUfXYc1G' =4 w, •C.b;M CONTRACTOR LIC.#(REQUIRED):tU ��937K LI CITY OF EVERETTbUSINESS C.#(REQUIRED):T �PRIMARY CONTACT: ❑OWNER atOONTRACTOR ❑OTHER(Please Specify) y - CONTACT NAME: CONTACT PHONE: 1 LO — �L-fit/) 1-pk, A-� x,� y) CONTACT EMAIL:�� a C�V,.. ..eve-Zak"`vCTTA VI k�I -p,('�n'tU •C)-.1dCY. A EEME�I hereby certify that!Mave d and examined this application and know the same to bb truekand correct. All pisions of laws and ordinances gove)4iing 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!am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 44 E Z52 - (3L O Owner/Au horized�ge t S nature �� Da e" (Revised 1/11/2019) Page 1-Application