3207 COLBY AVE 103 2022-01-27 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 wecuinr_rnN (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwra.gov I www.everettwa.gov/pe PROJECT SITE INFORMATION PROJECT ADDRESS: Oe.s X AV ( ©3 IBUILDING ARE ; : ��Q sq ft PROJECT TYPE: ❑ NEW CONSTRU N ,,DDITION ❑ TENANT IMPROVMENT ❑ RE ODEL BUILDING USE: ❑ SFR ❑ TOWNHO SE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # 6F UNITS• ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPT F WORK CONTRACT PRICE OF WORK: $ Qt� ASSOCIATED BUILDING PERMIT # (if applicable): 131 9 f — OZ7 DESCRIBE SCOPE OF WORK: ¢'o _ GeT't2lCA t- us o2� ® C®t-'ao :2— 13PrT'(t-Rmo s ��E12r ��41, �c.�GT�6GAtL u�GRAv7sS �`t� ��..I... THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ,/ Circuits-# .- A2X LJ 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: QNO ❑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: TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET •3 2 0 7 G' 1;4c-i3 `(0 3 CITY FZ STATE ZIP OWNER PHONE: If:PL 31f3— �3 OWNER EMAIL: CONTRACTOR NAME: M C G ('N, 1=(._lcCl i4(C_ Cc (N C CONTRACTOR ADDRESS: STREET 3-5'1 6- C) f S ySH , . n 7 CITY Cw ! "%- STATE {p+ ZIP .G 0 CONTRACTOR PHONE: 1{aS 3 C.s- O(a 3 CONTRACTOR EMAIL: Q-6 t C 9CT Pi C GtA kL_ CONTRACTOR LIC. #(REQUIRED): (AC,(.7 ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 03 Cr9 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: S IN M E AS A,$0QZ CONTACT EMAIL: c rr AGREEMENT: I hereby certiry that I have read ano examtneo rnis application and Know me same id tic uua anti cuncu. nu 1J V UIJO a"O a•,u, 0"• UO ew•�•^•^a •• •• type of work will be completed whether specked 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/ comply with the State Contractors Law 1827 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: .2, - �.� d E 2-co2 m !4- ner/ uthorize j ignatur Date (Revised 1/1112019) Page 1-Application L'