4805 EVERGREEN WAY LES SCHWAB TIRES 2021-09-22

`! riECTRICAL PERMIT APPLATION EVERETT CITY OF EVERETT PERMIT SERVICEb 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: IJ04,5 fAaji-Val , L.t/(l��f BUILDING AREA: sq ftt PROJECT TYPE: LJ NEW CONSTRUCTION I-I ADDITION ❑ TENANT IMPROVMENT REMODEL Rt''( ce + lh I Ot')ml na"•'ei Sic(Yt BUILDING USE: -I SFR ❑ TOWNHOUSE DUPLEX —I ADU MULTI-FAMILY-#OF UNITS: 'COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ •L`} D ASSOCIATE BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: gat-Ice spool* 61( i- 111-fGei"altui ttki„,f'ninet fe :i5j/). THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? „ 'NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO , YES-#of Devices: { SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ 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): S i 5;1 RCS 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, elected 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:NVO 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. ��,,,"^�n CONTACT INFORMATION OWNER NAME: 3 v to. /Noe* W)rtf , I f tTENANT BUSINESS NAME(If Commercial): L& 5cjt1 OWNER MAILING ADDRESS: STREET eo 9 t � i � CITY t f(,. k 1 tJ STATE IL ZIP 9g 6} OWNER PHONE: \"!� I- - ' 9'CCc/1 TOWNER EMAIL: i 7/4 • CONTRACTOR NAME: ON CI --AV L.0)(pj4Uj , CONTRACTOR ADDRESS: STREET t)(�(}� P t''I_(f)Lj i A Fh CITY V ( , W / STATE Wk. p,, ZIP ggd7-3 CONTRACTOR PHONE:, - I)4 J395 CONTRACTOR EMAIL: Pey'y)11+S(9 ,n.e)eJ-5;5i ` e-07) CONTRACTOR LIC.#(REQUIRED): e 32 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 57310 PRIMARY CONTACT: ❑OWNER IONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3iiel •-Lf u- "e) 3'01aq CiI e CONTACT EMAIL: --e.rmi '.f mter564 •C-1 AGREEMENT:I hereby certify that 1 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#: E 2-\03 - Dorn Ow r/Auth ized A_ tSignature Date (Revised 1/11/2019) Page 1-Application