6920 SEAWAY BLVD 2021-09-08 - Laserfiche WebLink

• • 1 11 mi 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 I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: . 0 ,c�A vJAj .431\J 0 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: �'COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ t.�f) - ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: € nj - Skt Of/A f:_e_ !l� f,belie ad I PI t' ?�x s l�lhti i/ ref,vp. 6, .-� AL' zi it i /44 THIS INSTALLATION INCLUDES THE FOLL WING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO YES-Select Scope: El Service ❑ Feeder ❑Circuits-#: a Complete Re-wire LOW VOLTAGE WORK? [a NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat El Audio El Secure Access El Security System El 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. E Other(List All): CODE_COMPLIANCE - IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [ NO El 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: ONO 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: 1tl ki✓ TENANT BUSINESS NAME,(If Commercial): OWNER MAILING ADDRESS: STREETbl la ik ¶ r t i �. 1?.re'b ITY 'F"ITE e ZIP / 6 zv 3 OWNER PHONE: % ' OWNER EMAIL: CONTRACTOR NAME: r„kr /ee l h( )JAI [ %' (1 `,, 5 S4e644S CONTRACTOR ADDRESS: sr`" DO �/1J efi/ Y� e(9)0 / + SO ll ' 1/C - /C� (' CONTRACTOR PHONE: tit J ',,!I �' CONTRACTOR EMAIL: },r7 ij,j- l';etem e 1edr(l - cL..,e,, CONTRACTOR LIC.#(REQUIRED) YYVE c- 1- t) LJG/-tJ CITY OF EVERETT BUSINESS LIC.#(REQUIRE PRIMARY CONTACT: ]OWNER ❑CON TRACTOR ®: v :., s�.._, -.�� m:.�. ._ ../} ❑OTHER(PleaseSpecify) cD , CON CT NAME: CONTACT PHONE: j'%Z5_ 113- ci y8 'I b lei CONTACT EMAIL: AGREEMENT:()I')by 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 regulating construction or e 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 ltit t e State Contractors aw 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ) ' i„,t- c/lc. 61 /�i E nCE,..- \.q Own r/ orized Agent Signature Date (Revised 1/11/2019) Page 1-Application