1532 GRAND AVE 2022-01-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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: 1532 Grand Ave BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: []COMMERCIAL ELECTRICA4!AP►LICATIQN "INIFQRMATION CONTRACT PRICE OF WORK: $1700 &DESCRIRTION OF WQRK, 1ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: 3-20A Circuits (1 for bedroom, 2 for outlets) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ® YES - Select Scope: ❑ Service ❑ Feeder ® Circuits-#: 3 ❑ 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: RI NO El 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: ✓ NO LYES -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. "m CONTACT INFORMATION OWNER NAME:Tom Mara TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 1532 Grand Ave yin Everett STATE WA Z,,98201 OWNER PHONE: 2067141 639 1OWNER EMAIL: Thomasmara@gmall.com CONTRACTOR NAME: witch Electric CONTRACTOR ADDRESS: STREET 7226 139t Ve CITY Lake Stevens STATE A ZIP 98258 CONTRACTOR PHONE: 425-244-5511 CONTRACTOR EMAIL: service 9 myswltC e ectrlc.corn CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Tiffany Erickson CONTACT PHONE: 253-376-7662 CONTACT EMAIL: tiff anyg myswltc e ectrlc.com —Y ninny u'm , nave reau anu exannneu un5 appncatlon and Know the same to oe true and correct. All provisions or 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 1 am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: 1/15/20 E(- Owner/Authorized Agent Signature Date (Revised 1/1112019) Pa e g - pplication 6",