Laserfiche WebLink
W ECTRICAL PERMIT APPLIaTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 1.11j":‘ <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425.25Y-8857 I(E)everetteps@everettwa.gov I www.evereitwa.gov/permits <br /> PROJECT RITE;INFORMATION <br /> PROJECT ADDRESS: P0-2.:2 t.r CC V)' BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑MDITION [I TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU LI MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> 2. ELECTRICAL APPLICATION INFORMATION.& D ESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 140 000 ASSOCIATED BUILDING PERMIT#(if applicable): �. <br /> DESCRIBE SCOPE OF WORK: 5�- {,( ( �S �— <br /> p ,�f - ev eno--- tylS <br /> oiAci R.C.4 c (AA--[ I t r°S kfrtk v (U <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑YES-Select Scope: [. ice bfeeder ❑Circuits-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data Li Intercom ❑Thermostat ❑Audio ❑Secure Access ❑ Security System <br /> L] Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> CODE COMPLIANCE <br /> 6 THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: L iio I_J YES--See Below&Pg.2 <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Paget require Plan•Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: LINO EYES-See Below&Pg.3 <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> She Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> Olt(►NER NAME: TENANT BUSINESS NAME(if Commercial): Boeing <br /> ytr Rln: <br /> OWNER MAILING ADDRESS: STREET PO BOX 3707 <br /> ciTY Seattle <br /> STATE WA Z1e 98124-2207 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: General Construction Company <br /> CONTRACTOR ADDRESS: srfeer <br /> POBox46 WA <br /> tY CITY Mukilteo STATE zip 98204 <br /> CONTRACTOR PHONE:425-294-6944 CONTRACTOR EMAIL:Bridgett.Burnsiaikiewit.com <br /> CONTRACTOR LIC.#(REQUIRED):GENERCC984OZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):040599 <br /> PRIMARY CONTACT: LOWNER I✓.iCONTRACTOR <br /> ��•-ram <br /> LIOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-730-6546 <br /> Dennis Crow CONTACT EMAIL:Dennis.crow@kiewit.com <br /> AGREEMENT:l hereby certify that l have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. Thai t am authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 298.200 WAG. City of Everett official Use Only <br /> PERMIT#: <br /> C - fib.--4-1 ci E G\10 — ` I �— <br /> ner/Autho d Ag ignature Date (Revised 1/11/2019) Page 1-Application <br /> :ic � C? '3 <br />