1520 W CASINO RD BLDG B 2021-12-20

EVERETT WASHINGTON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1520 -r eAsft.10 jkcAipaVl h ,2.0 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION M TENANT I REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU © MU I -FA ILY # OF UNITS: IZ- ❑COMMERCIAL ELECTRICAL'APPLICATION INFORMATION & D RIPTION OF WORK CONTRACT PRICE OF WORK: $ Coo ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: 6P 1A t! EIe ov vwIRE pAmAg_,FD AS FOR I3VILrafNC, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO [YES - Select Scope: ❑ Service RFeeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? Wt NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): El Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access -1 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 296-4613-900, 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: ONO ❑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: 5tjj4RCo c bE to TENANT BUSINESS NAME (If Commercial): GR6 vIE -r5 OWNER MAILING ADDRESS: STREET 1520 T o CITY Evot RET T STATE Wh ZIP 9eZO OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CORr, CONTRACTOR ADDRESS: STREET P.O. o CITYWckyn1N VILL 1E STATE VUh ZIP 9faO'72- CONTRACTOR PHONE: pV . 5 ol-53 CONTRACTOR EMAIL: joe Q e F E CONTRACTOR LIC. #(REQUIRED): Co RC kH ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 5oq PRIMARY CONTACT: DOWNER ®CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: JO E H PEKR AUtm CONTACT PHONE: 2-04, b5 0133 CONTACT EMAIL: t7E AGREEMENT: I hereby certify that/ have read and examined this application and know the same to be true 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/ am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: S-2-94. 11 E �Qj OenOlAutgorizecl Agent Signature Date (Revised 1/1112019) Page 1-Application