1205 26TH ST 2021-09-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES • 3200 CEDAR STREET, EVERETT,WA 98201 477 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits • SITE INFORMATION '=_ " igitarg " PROJECT ADDRESS: .4 -26th Street BUILDING AREA: 400 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL • ELECTRICAL APPL C e CONTRACT PRICE OF WORK: $ 250.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Provide electrical connection for temporary construction trailer to existing electrical service for Jansen. kAWC THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope. El Service ✓0 Feeder ❑✓ Circuits-#:9 El Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El 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): 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 296-46B-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: ✓❑NO 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: TENANT BUSINESS NAME(If Commercial): Jansen. Inc. OWNER MAILING ADDRESS: STREET 1215 W. Holly Street c, v Bellingham STATE WA zip 98225 OWNER PHONE:360.739.2018 OWNER EMAIL: CONTRACTOR NAME: Service Electric Co., Inc. CONTRACTOR ADDRESS: STREET PO Box 1489 CITY Snohomish STATE v v`/�' A Zip 98291 CONTRACTOR PHONE:360.568.6966 CONTRACTOR EMAIL:sharon@secoinc.com CONTRACTOR LIC.#(REQUIRED):SERvIEC564RU CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 029064 PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.508.2605 Andy Poat CONTACT EMAIL:andy poat@secoinc.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 regulating construction 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 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: g . G 01 7_oe l e E 16 7 0 5 �. Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application