1321 COLBY AVE 2ND FLOOR 2022-01-26

• i ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 wnsuracrnN (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: U L1 �' e? I �j Jt T Vert-f WrC Itzo BUILDING AREA: sq ft d PROJECT TYPE: ElNEW CONSTRUCTION ElADDITION ❑ TENANT IMPROVMENT 2 REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION. OF WORK''. CONTRACT PRICE OF WORK: $ - y �1 i(? ASSOCIATED BUILDING PERMIT (if applicable): U- U (# yY2- DESCRIBE SCOPE OF WORK: r,d sl �� OG�Gt d IGCC++zGn�F �i�SG THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO YES - Select Scope: ❑ Service Feeder ❑ Circuits-#: ❑ 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): CODECOMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7NO j 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 ❑YES -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: 9?r-0v =d"_,, lGC dui 4 rd�Lc��u TENANT BUSINESS NAME (If Commercial): a OWNER MAILING ADDRESS: STREET d C •n = ✓�� / CITY ��I STATE tt ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 1'CGf�' C_ 4- 6010 CONTRACTOR ADDRESS: STREET S�(p ;A� �v CITY e— STATE CONTRACTOR PHONE: ''fib(O-136-S Z0'0 CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): /Fr_A F_El' eZ 10 Q CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: []OWNER ]CONTRACTOR ❑a OTHER Please Specify) CONTACT NAME: - CONTACT PHONE: `%®(o .Cjs�f) - 5 -47 35 r ti?9la CtICJ�� .... CONTACT EMAIL ��-Soyl . `��^ Gtee n doi �'Yi .. .. .. _._ _ ._.._ __J ___-__a nu ...... .:..:...... „s r,......,„,d ....Un�nroc nn in thm AGREEMENT: I hereby certify that I have read and examined this appucauon and know ine same ru uc a ue and Goirec' . Pro �..� �•.� �. �.,.u.. •. •.• •y • •• 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/ 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 #: � 30 r E �(lU� �� Ownerlduthoriz Agent Signature Date (Revised 1/1112019) Page 1 Application F � lam,