6920 SEAWAY BLVD 2021-09-08 - Laserfiche WebLink

is S ELECTRICAL PERMIT APPLICATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 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 ADDRESS: 0920 ± AWA... I �LV `{' 2J BUILDING AREA: sq ft • PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL CONTRACT PRICE OF WORK:$2,50D,( ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: rd �1L ! ,A �x ITS Zit-4P is THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY L LINE VOLTAGE WORK? ❑NO ❑YES-Select Scope: ❑Service ❑ Feeder Circuits-#:`J ❑Complete Re-wire • LOW VOLTAGE WORK? NANO ❑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): • 19 IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 1% NO YES--See Below&Pg.2 n 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 I 1 of this application(see next page),AND Plan Review is NOT required because I meet all of the follow' g sub sections that co not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO DYES-See Below&Pg. 3 (i Pursuant to RCW 19.28.261, 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. OWNER NAME: TENANT BUSINESS NAME(If Commercial): 1 -^' OWNER MAILING ADDRESS: STREET CITY STATE w 21I9.6 OWNER PHONE. S 61C0 OWNER EMAIL: CONTRACTOR NAME: /vlC W L � � CONTRACTOR ADDRESS: sT�sr 6( `2 J �V S rr�� CITY STATE `�� ` LIP ci�f-.-J4-�O FD CONTRACTOR PHCIWE� CONTRAVOR EMAIL:J _ S 000 CONTRACTOR LIC.#(RE D`,)].41 J kr -�„ J CITY OF EVERETT BUSINESS LIC.#(REQUIRED):_ L 22-. "' t PRIMARY CONTACT: DOWNER ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ., 5 �1►� �Nr"1 CONTACT EMAIL: -B) .AJv J24,x . `"""" -{ AGREEMENT!hereby certify that!have read and examined this application and know the same to be true and correct. Ali provisions of laws d 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 tam authorized by the owner of this property to perform the work for which application is made end I comply with the State Contractors Law 18,27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Owner.•uthorized Agent Ignaturb Date (Revised 1/11/2019) Page 1-AppllcatIon