8615 7TH AVE SE 2021-02-26 - Laserfiche WebLink

MIN • ._ ELECTRICAL PERMIT APPLICA� •Fl CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: S dC,Q j 1 n7.AVE- <aC BUILDING AREA: / , 2-3 sq ft PROJECT TYPE: El NEW CONSTRUCTION ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: IB COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ �3©, Z 0 0. 00 ASSOCIATED BUILDING PERMIT#(if applicable): ts 9 0 z DESCRIBE SCOPE OF WORK: IV Y ) LI 4/I Ti i L1 4h/7:M4 (Aig,l 2 W i%S A-0o k(Yt- Oe4 (S THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO YES-Select Scope: ❑ Service N Feeder Circuits-#: ' ❑ Complete Re-wire LOW VOLTAGE WORK? ® NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat ❑ Audio ❑ Secure Access El 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 COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: rki 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: ONO 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. CONTACT INFORMATION OWNER NAME: ' Y" Q S-1 "I 1 Sr TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET .7101 CITY ( STATEtAiN ZIP /J'v�4 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: P EF-EN4,09 CLf 'M'ICE CONTRACTOR ADDRESS: STREET 77—I L() (j/`��[y MCI, S 4 /� STATE WA ZIP '-/ CONTRACTOR PHONE: 7�0 Mtt 0b9 CONTRACTOR EMAIL: rfcc,preferre.cle (ecf i '. VS CONTRACTOR LIC.#(REQUIRED) PkE FEEL L CITY OF RETT BUSINESS LIC.#(REQUIRED): � � PRIMARY CONTACT: DOWNER C]CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: /� CONTACT PHONE: u/6 eG1..C'r�, 6t9,1 �r�� /% V�� CONTACT EMAIL: L7 if /f/P.., v'v-(10/e��1'f 4 C`S AGREEMENT:I hereby certify that I have read and examined this application and know the sa o be true-End orrect. 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#: A IA\ 1 '`CL E \(2( 0(6" OZ Own. Authori -d A.-nt Signature Date (Revised 1/11/2019) Page 1-Application