1915 JACKSON AVE 2021-08-26 - Laserfiche WebLink

• • lijol ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMAT16 7;4 ':. PROJECT ADDRESS: 1915 Jackson Ave. BUILDING AREA: 2000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ✓❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL irliELECTRICWAPKICATiON M ' TION &DESCRIPT1W4.... CONTRACT PRICE OF WORK:$ 2500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replace Service Panel 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 ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑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. ❑ Other(List All): ;„„„..,, ,,,:,,, ,, Cr ,. ANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO LI 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: ENO EYES-See Below&Pg.3 Pursuant to RCW 1928.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I�/ I 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. CAN .....y.... T INFO19 � OWNER NAME: Greg Landsiedel TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1915 Jackson Ave.�n-v Everett STATE Wa' ZIP 98203 nuvNF_R PHONE:425-343-2928 OWNER EMAIL:landsiede11960@msn.com •CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ['CONTRACTOR ['OTHER(Please Specify) CONTACT NAME:Greg Landsied CONTACT PHONE:425-343-2928 CONTACT EMAIL:landsiede11960@msn.com AGREEMENT:I hereby certify that I 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 regu ting struction 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 w'h St to Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: EDDOA-4 ' 2 OwneilfAuthitrized Agent Signature ate (Revised 1/11/2019) Page 1-Application