3016 NASSAU ST 2021-06-10 - Laserfiche WebLink

® • ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 wnsHiNGTory (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwagov I www.everettwa_govfpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 3016 Nassau St BUILDING AREA: so ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION n TENANT IMPROVMENT ✓Q REMODEL BUILDING USE: t+i SFR ❑TOWNHOUSE El DUPLEX. ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK OO ASSOCIATED BUILDING PERMIT#(if applicable): JDESCRIBJ�SC PE OF WORK: Add 50 amp spider cord. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ®NO ❑YES-Select Scope: []Service ❑Feeder El Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: --tt SELECT SCOPE(REQUIRED): ❑ Data ❑Intercom ❑Thermostat u Audio El 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. 0 Other(List All):50 amP spider cord CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HFAI TH AND/OR PERSONAL CARE FACILITIES: n NO ❑YES--See Below&Pg.2 l I 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: ZNO EYES-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: Brian Adams TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3016 Nassau St crry Everett STATE WA 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: D&K Electric, Inc. CONTRACTOR ADDRESS: STREET PO Box 2117 cny Lynnwood STATE WA 7,, 98036 CONTRACTOR PHONE:(425)742-7654 CONTRACTOR EMAIL:dandkeiectric@comcast.net CONTRACTOR LIC.#(REQUIRED);DKELEK970KK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 40151 PRIMARY CONTACT: DOWNER ;CONTRACTOR [✓OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(206)793-1418 REV /t CONTACT EMAIL:oandkelectric@comcast.net comcast,riot AGREEMENT:/hereby certify that f have read and examined this application and know the same to be free and correct. All provisions of laws 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: r E -- 1 - e e horized Age ' atur Date (Revised 1L1112019) Page 1-Application