1321 COLBY AVE 2ND FLOOR 2022-01-26

• PERMIT APPLICATION TION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits '.PROJECT SITE 1NFOMMO& I ON PROJECT ADDRESS: 1 L\ C_i k b +'� v �� t t4 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ZREMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY # OF UNITS: OMMERCIAL ELECTRICAL APPLICATION INI=ORMATION &DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 6 - yv-14- ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO%LYES -Select Scope: ❑ Service ❑ Feeder ircuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? �NO ❑ YES- # of Devices: ❑ ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System SELECT SCOPE (REQUIRED): Data ❑ 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 WAC 296-46B-900, select d the specific reason on page 2 ❑By checking this box, I am stating that I have read and understand all of 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. WITHOUT ELECTRICAL LICENSURE: ONO ❑YES -See Below & Pg. 3 ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR 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 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement See Page 3 CONTACT INFORMATION r OWNER NAME: 1 r� ' �1C4 �� d3�c TENANT BUSINESS NAME If Commercial OWNER MAILING ADDRESS: STREET t (> L' ^ 4 %; � q( GJ74 1 STATE ZIP L✓1 CITY (`� OWNER PHONE: OWNER EMAIL CONTRACTOR NAME: �' G�"'T Glec*- �-- CONTRACTOR ADDRESS: STREET ZIP STATE i CITY CONTRACTOR PHONE:' U& ' '� CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED):wF,=�-t J Z A CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR THER (Please Specify) i 1c� Cdd'1 C.rc (re r °+.tit , CONTACT NAME: CONTACT PHONE: yt)(., (( CONTACT EMAIL: .,r �a — and nrdinances aoverninq this AGREEMENT -'I hereby certify that I have read and examined this application and know me same iu un e �t au �- „ P---• -••- - --- - - 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 1 am authorized by the owner of this property to perform the C or of Everett Offic afor which tl Use ion is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAGPERMIT#: Only (Revised 1/11/2019) Page 1-Application ner ut yAgent e