4030 RUCKER AVE 2021-04-01 - Laserfiche WebLink

I� ELECTRICAL PERMIT APPL 'ATI J CITY OF EVERETT PERMIT SERVICES _.x(r U 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.g6v ir . L rC WORK PROJECT SITE INFORMATION W��KS PROJECT ADDRESS: 4030 RUCKER AVE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: REWIRE ILLUMINATION OF GAS PRICE SIGN ON POLE SIGN; NOT LOGO'D CABINETS. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO El YES-Select Scope: El Service El Feeder ❑✓ Circuits-#: 1 El Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom El Thermostat ❑Audio El 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: ✓❑ NO El 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: ✓❑NO 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: ,JH KAUSHAL LLC TENANT BUSINESS NAME(If Commercial): ARCO AMPM OWNER MAILING ADDRESS: STREET 4030 RUCKER AVE CITY EVERETT STATE WA ZIP 98201 OWNER PHONE:425.789.1620/206.841.4992 OWNER EMAIL:nareshpkaushal@gmail.com CONTRACTOR NAME: MEYER SIGN CO., INC CONTRACTOR ADDRESS: STREET2608 HWY 99 SO ciTY MOUNT VERNON STATE WA Z,P 98273 CONTRACTOR PHONE:360.424.1325 CONTRACTOR EMAIL:PERMITS@MEYERSIGN.COM CONTRACTOR LIC.#(REQUIRED):MEYERSC83238 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 57310 PRIMARY CONTACT: ❑OWNER (CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360.424.1325 C HAZ D U GAW CONTACT EMAIL:PERMITS@MEYERSIGN.COM 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 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#: 07/24/2020 E Z6 G b-0 g Owner/Authoriz d- nt Signature Date (Revised 1/11/2019) Page 1-Application