3201 SHORE AVE 2021-04-01 - Laserfiche WebLink

I BIM 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)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION ; PROJECT ADDRESS: .-O 1OiL� � A/C- Eve/tet L✓l %a3 BUILDING AREA: 2.\Od ql sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ,i REMODEL BUILDING USE: Q'SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION.INFORMATION'& DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 9560 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: -lief 1Coor iti3,56d ( klichol 1 ZJv,, ," /,,weve), THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO YES-Select Scope: ❑Service ❑ Feeder, Circuits-#: 7 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ 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. ❑Other(List All): CODE COMPLIANCE;` IS THIS PERMIT 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 AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:'TNO 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: .S, <7pt ,4E iCGL++1 NANTBUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 32,C C -a'-c►oi@ At - CITY G ') STATE ZIP /U a OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: E(,Q a v/7177AC6 LLELC MC CONTRACTOR ADDRESS: STREET "7/3,3 77i,rwQ/7e1 dr- rr- CITY // > 2+ /" STATE"� /��C ZIP 949do3 CONTRACTOR PHONE: 24 --4,6 - YI/7 CONTRACTOR EMAIL: eco/p.,4, c ce , (`� yl ).. COO-hi 'CONTRACTOR CONTRACTOR LIC #(REQUIRED) �/(� Z CITY OF EVERETT USINESS LIC.#( QUIRED)'i1 3'j PRIMARY CONTACT: DOWNER ,CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206 4f`r6-- 1`J��/7 .[ 2 am 2-0/1oS CONTACT EMAIL: etc h4,A��'-. eh C /'JC `►'ram,• G AGREEMENT:I hereby certify that I have read and examined this application and know the same to a true an/correct. All provisions law 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 can el 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#: 08 26 „ E O e gent Signature Date (Revised 1/11/2019) Page 1-Application