4310 COLBY AVE 2021-11-12 - Laserfiche WebLink

• 41111 �` ELECTRICAL. PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES �* .. 3200 CEDAR STREW EVERETT,WA 98201 (P)425-2574810 I FAX 425457 57 I(E)evereuepsiereftwa.gav I wwtiv.e vereitwago videmitts .. - r •,'t71;i :a PROJECT ADDRESS: 413e6 coe$y AvC BUILDING AREA: aq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION al TENANT IMPROVMEl3 i" CI REMODEL BUILDING USE: 0 Sf'R 0 TOWNHOUSE 0 DUPLEX CI ADO` D MULTIFAMILY #nF UNITS: Ct NIf ERCIAL ��#R rt c s o ate' '��" kY ,�"�"�."-,�' "�;'�•:'.r e/�. � �. �.� a ci;��' ,>....�u r,�?�_» x.z»:� . .pair: .'..._... -: � s:ea>..mzrs�n � �« ...�.. .. • a r CONTRACT PRICE OF WORK:$ Igloo � ASSOCIATED BUILDING PERMIT#(if applicable): - 2i10 —M DESCRIBE SCOPE OF WORK: Jus-rAu. ypwnfTA&`I Fttz,E At Artr`• Sy s?tt.rvr. fort EL 1A?cam AL.L ' THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? Iwtt NO 0 YES-Select Scope:0 Service 0 Feeder 0 Clrcuits4 0 Complete Re-wire LOW VOLTAGE WORK? Cl NO YES-#of Devices. Zto SELECT SCOPE(REQUIRED): 0 Data Cl Intercom 0 Thermostat C1 Audio 0 Secure Access 0 Security System TiPil 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. 0 Other(List AN) IS THIS PERMIT EDUCATION,INSTITUTIONAL, o ;z F HEALTH AND/OR PERSONAL CARE FACILITIES: NO B YES--See Below&Pg.2 El 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 Pegs 2 regtirre Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:EjNO OYES-See Below&Pg.3 D Pursuant to RCW 10,28.281,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 sea Fags 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement, �,�f?. •� �i" - aF b�:a� AK' Y:�aY°."�..:..;�.,y�,....,_.. s. s --r .�.: ,o .� .`•,�.... ,r � w�` ` �;�;`a::;#: t:� ..t OWNER NAME: MA-TANA LLir- TENANT BUSINESS NAMEUIf Commercial Coh ay tOKA1- Riau" DOWNER MAILING ADDRESS: srae r )t") EAV Loy pSott 'T SDI' . Z3C crrr IAM WA 2P 9$I0Z OWNER PHONE: 20(o 5 5" 41611 OWNER EMAIL: CONTRACTOR NAME: 11 it,N he-6 CONTRACTOR ADDRESS: $1R T 'R) Box 331 CITY AQL.iA16 Io STATE wA z 'gli 22.3 -CONTRACTOR PHONE: LtZ4 2W1 ?P4S CONTRACTOR EMAIL: --xEff Ed, f3NHF IRt:•Cove CONTRACTOR LIC.#(REQUI ): EiNt%tR atf 6421CrJ 'CITY OF EVERETT BUSINESS LIC.t OUIRED):SVd1 7 PRIMARY CONTACT: ©OWNER tit CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Aiz.6s Z1414 f14tf5 cll f $iav95/42.6 CONTACT EMAIL: -Sip.' Q I3k) =�eat.Got'h At3REE'I Elti `t hereby atMti rf3 )have reams examined this pppscatk n and mow the same to be true and dotted. AP pestesbns Awe and ordieences governing this type of work will be tonotetedwhether spectitec huh or not. The granting ota RUM*dues not mew*to(Pve eulhtxy to vioi®te°roarreel the provisions crony other stete or Wei Jew regulating constivotion or the perlerrrrence 01 construction. That t am authorized Odle owner of ails peapmty to perform the work tar tenth a ctillon is mane and I comply with the State Conte Lev 18.27 RCW end 208.200 WAC City of Everett Official Use Only PERMIT* OwnedArAzad Agent SignatureDate (Rev r11112019) 1-AppliratIon