6202 ASSOCIATED BLVD 2021-10-12 - Laserfiche WebLink

So ELECTRICAL PERMIT APPLICATION isP CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-88s7 I(E)everetteoseevereftws.gov I wiim everettss.goWpsmlts PROJECT ADDRESS: (a2a2 At.Soc.i 4 c.A t-VI BUILDING AREA, sti ft PROJECT TYPE: Cl NEW CONSTRUCTION 0 ADDIT1O1;' TENANT IMPROVMENT C3 REMODEL BUILDING USE: CI SFR Cl TOWNHOUSE 0 DUPLEX CI A?t1 0 MULTI-FAMILY-#OF UNITS, COMMERCIAL w"< LL $ ::>� '`s �.. sZ.., 2Z�v `� ASSOCIATED BUILDING s CONTRACT PRICE OF WORK: PERMIT S(if applicable): DESCRIBE SCOPE OF WORK: F I as At.Artrn '►•nceI P,cA f iu i)5 1:oi¢. eE F ILA a M L THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:!SELECT ALL THAT APPLY) LINE VOLTAGE WORK? �NO 0 YES-Select Scope:CI Service Ci Feeder 13 circuits-#P C]Complebs Re-wire LOW VOLTAGE WORK? C NO YES-$of Devices: �D SELECT SCOPE(REQUIRED): ICI Data C]Intercom C]Thermostat CI Audio ©Secure Access 0 Security System 13 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An€dditional Fire Alarm Permit Is required for review of device location and Installation approval ❑Other{List Ail) ' "z.`" `!.. a. �'.., a b f IS THIS PERMIT EDUCATION, `e / .�. ` INSTITUTIONAL HEALTH ANDIOR PERSONAL CARE FACILITIES: !I NO ■ YES--See Below&Pg.2 D By checking this boss,I am stating that I have read and understand all of WAC -ASB-Butt,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. -r YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSUR NO OYES-See Below&Pg.3 0 Pursuant to RCW 19.28.281,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or was without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and see pep 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. *WEER NAME: DAV IS 3A a v6 TENANT BUSINESS NAME(If Commercial): HARVt`1 OFFIc.. 112 • 4-<MAILING ADDRESS: STREET I C?600 3)sT WAy AIL crn Q v c C) STATE wA 9fS'05 t + asn OWNER EMAIL: CONTRACTOR NAME: a 4 H F/lLE' CtN3TRACTOR ADDRESS; STREET Po BOA. "" 37 I] coy Ak"-TO,N STATE LA z' 223 CONTRACTOR PHONE: 112-c 244 ]t-1115 CONTRACTOR EMAIL: "ZePF � at.) .(DY' \ ONTRACTOR LIG.#(REQUIRED) I31Af• ILtif$LIZ C ,) CITY OF EVERETT BUSINESS LIC,#(REQUIRED): °SSS&i7 PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425 244 1 tt Lf S - j .120Sr5A2Q CONTACT EMAIL. - E$ 1 4a. j3► r1 F I U .ccfne, rtOREEPAEArk I hereby oartiy that t have reed and*remitted this appitnation and snow the same to be true and cooed tiff preictsiami°Haws and G governing this type of work wfbe cexrrorated whether specified hatpin or not. The granting of a pen*does not preswne to give authorityto violate or'cence9the errs dairy other stare or Warms,regulating conetnictiOn or the peAwmanca of construction. That 1 am authorised by the owlet of this property ty to tam the work for which agilicetfon i made and t comply wth the Slate Co nkra:to s Law i8 27 RCA and 2n 8 200 WAC City of Everett Official(Ma Only 'PERMIT it: �� 61 a Zcn\ E Z� , a 21 Owner/A Agent Signature Date Owiseri 1t1112010 Pap 1-Application