1001 E MARINE VIEW DR 2022-02-01

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 menc n97 001n I CAY d9F_9Ci7_RR57 11F1 P.vP.rP.ttens0evere1twa.gov I www.everettwa.gov/permits -PROJECT SITE INFORMATION' PROJECT ADDRESS: C V BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT tIREMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: COMMERCIAL ELECTRICAL: APPLICATION :INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ -- ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: 6 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 0 YES-# of Devices: 7 ?L..,1 Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System SELECT SCOPE (REQUIRED): ❑ Data 0Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional Ire larm Permit is required for review of device location and installation approval. ❑ Other (List All): CODE COMPLIANCE IS THIS PEIT EDUCATION, INSTITUTIONAL, HEALTH ANDlOR PERSONAL CARE FACILITIES: NO YES See Below & Pg. 2 RM By checking this box, I am stating that I have read and understand all of WAC 296-46B-900, s ected the specific reason on page 2 do Elof this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that not See Page 2 require Plan Review. eeec7777ffff OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: PNO YES -See Below & Pg. 3 ARE YOU AN Pursuant to RCW 19,28.261, property owners and leaseholders cannot perform electrical work on bull ings for rent, sale, or lease I have and ❑ without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that completed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. See Page 3 signed CONTACT..INRORMATION OWNER NAME: TENANT BUSINESS NAME If Commercial OWNER MAILING ADDRESS: STREET _ yCITY STATE ZIP OWNER PHONE: C OWNER EMAIL: CONTRACTOR NAME: 'J CONTRACTOR ADDRESS: STREET ZIP STATE CITY CONTRACTOR PHON , - CONTRACTOR EMAIL: l Writ CONTRACTOR LIC. #(REQUIRED): CITY OF EVERET USINESS L .#(REQUIRED): PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: %dC woJ • *this earl P.— lhp .camp to hY tru d correct. All DrQ ions of laws and ordinances govern AGHLLMtIVI:InereoyGeriuyuldllylavc,cwuw��....................rr••-_.._.._.._....__-. - 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 I am authorized by the owner of this property to perform the Citywork of Everett Official Use for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC.Only PERMIT #: Owner/Authorized eat 1 ature Date (Revised 1/1112019) Page 1-Application