1321 COLBY AVE 2ND FLOOR 2022-01-26

f &ECTRICAL PERMIT APPLOATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps©everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: E _'�.Z \ Cc i b Ave BUILDING AREA: PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT EMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: PRICE OF WORK: $ 2©, ooc) DESCRIBE SCOPE OF WORK: JASSOCIATED BUILDING PERMIT # (if applicabl, i-- Ed G.:.: i i _F� — L,) . rl ILI COMMERCIAL INSTALLATION INCLUDES THE FOLL WING 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):_ 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, select d 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: ONO EIYES -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. OWNER NAME: i -c,� . tvxeL k�,-, -M" 11 A ( A r TENANT BUSINESS NAME if Commercial): OWNER MAILING ADDRESS: STREET I !&C1 (� r` t� J SLZ: 0 `7016 CITY STATE LcJ4 ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: V2 Cr4- C[ cr, L Cl-' i ,_(;1 CONTRACTOR ADDRESS: STREET 5 6 % CITY f"f'(C— STATE CONTRACTOR PHONE: ZG(,,, y3 2 c o CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): V EC_4A 1=f bZk o Cs- CITY OF EVERETT BUSINESS PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: �� _ �. U 1 S I I BSc - . IC. #(REQUIRED): C �l'11vJt. CONTACT EMAIL: AGREEMENT.• 1 hereby certify that! have read and examined this application and know fhe same to be true and correct. All provisions of taws 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 violates cancel the provisions of any other state or local law regulating construction or the 18.27performance of construction That / am authorized by the owner of this property to perform the work for which application is made and I comply, a State C ract s La 18.27 R and 298.200 WAC. City of Everett Of clal Use Only E)D /13 zO D/P'Owner/Aut razed Agent Signature � Date (Rev/sed 1/11/2019) Page 7-Application