Laserfiche WebLink
0 <br />NMI <br />EVERETT <br />WASHINGTON <br />Is <br />• <br />ELECTRICAL PERMIT APPLICATOR <br />R <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />�� <br />PROJECT SITE INFORMATION <br />f <br />PROJECT ADDRESS: J cC) l P_.) Gl 1! - E - C rc, + <br />BUILDrrIN**��G AREA: I Z L V sq ft <br />El�� <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION TENANT IMPROVMENT 1 REMODEL <br />ti--II <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: I COMMERCIAL <br />ELECTRICAL APPLICATION''INFORMATION & DESCRIPTION'OF WORK _ <br />CONTRACT PRICE OF WORK: $ 2 U ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: Z C)(J C-11 ct <br />10 AWeC ^r <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ❑ NO AYES - Select Scope: ❑ Service ❑ Feeder 7 Circuits-#: I�L- ❑ Complete Re -wire <br />LOW VOLTAGE WORK? ❑ NO ❑ YES- # of Devices: <br />SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br />❑ Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional <br />Fire Alarm Permit is required for review of device location and installation approval. <br />❑ Other (List All): <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ;x NO 7 YES -- See Below & Pg. 2 <br />�j 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 <br />�f of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: QNO DYES -See Below & Pg. 3 <br />❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br />See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br />CONTACT INFORMATIE)N . <br />OWNER NAME: I C , 1,11 rre CCU lAL TENANT BUSINESS NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET IC (o1hy AUe- <br />CITY X �� + STATE ✓ ' ZIP <br />OWNER PHONE: Ll Z C" 9 ZZ-- <br />OWNER EMAIL: <br />CONTRACTOR NAME: j V eV1 Sr'1 %4L <br />CONTRACTOR ADDRESS: STREET' , 7 Lly'fL <br />CITY (1!-" STATE zip <br />CONTRACTOR PHONE: �lLSZ / -$( <br />CONTRACTOR EMAIL:NfG t C�✓ %�` <br />CONTRACTOR LIC. #(REQUIRED): ITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br /># <br />. <br />m.... r _� ._.. _-_ ..... <br />PRIMARY CONTACT: DOWNER NaCONTRACTOR [-]OTHER (Please Specify) <br />CONT�ACT NAME: <br />Sjf ` V&-) S%r j', <br />CONTACT PHONE( 2 � � � � _ (y � <br />CONTACT EMAIL:Qr^Vl' <br />AGREEMENT:1 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 <br />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 <br />local law regulating construction or the performance of construction. That/ am authorized by the owner of this property to perform the work for which application is made and/ <br />comply with the State Contractors Law 18.27 RCW and 295.200 WAC. City of Everett Official Use Only <br />PERMIT #: <br />- q - � E 2.0 C�34b� <br />OwneriXufhorized Agent Signature Date (Revised 111112019) /Page 7-Application <br />C 3 <br />