812 93RD ST SW 2022-01-18 - Laserfiche WebLink

A RECTRICAL PERMIT APPLIRATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PRQJECT SITE INFORMATION, PROJECT ADDRESS: '�r ( ?-- ei 3 e-a ✓d 'ell " fix' UILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑COMMERCIAL <ELECTRI OWINFORMATIW& DESCRIPTION OF .VICORK ,...... ... . ^....; . CONTRACT PRICE OF WO : $ ASSOCIATED BUILDING PERMIT` # (if applicable): DESCRIBE SCOPE OF WORK: pC,} ''de ° j� ,qoK r r -er ),/ F I d Rc - l� THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT AP LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scope: ❑ Service ❑ Fe er Circuits-#: Z Complete Re -wire LOW VOLTAGE WORK? NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ A cure 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 ` ar 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 296-4613-900, 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 YES -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::INFORMAT1EtN ... .. . OWNER NAME: �okv t 0.0 IrJ9� TENANT BUSINESSNAME(If Commercial): OWNER MAILING ADDRESS: STREET 5ej-0 %ram/`e- In..X /— Jam] f°y��f G CITY 1 ` c^J \ TATE ✓ / ZIP OWNER PHONE: 60`- �- 2'L'F OWNER EMAIL: % D r h �i f>>r11— (L �J z'X C� CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: roWNER []CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: (2 o b CONTACT PHONE: 2 2- 4p6'7 CONTACT EMAIL: it C) t., Q 1 ,v e4"ff 0., AGREEMENT: I her y certifYthat I have read and xamined this application and know the same to be true and correct. All provisions of laws and ordinances governing tnls type of work will e c mpleted whether specified h rein 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 regula ng onstruction or the performa a of construction. That/ am authorized by the owner of this property to perform the work for which application is made and/ comply with th ate Contra s Law 1 27 R and 296.200 WAC. City of Everett Official Use Only PERMIT #: / nw�j 17-�20. E ZcD� C- A Own , /Authorized Agent Sig ure Date (Revised 1/1112019) Page 1-Application Cu /sue