1205 CRAFTSMAN WAY SLIP 40 DOCK G 2021-12-06

• • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 wAsminsroN (P)425-257-8810 I FAX 425-26743857 I(E)everetteps@everettwa.gov I vewveverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: CENTRAL MARINA G-DOCK, G-40 'BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION El TENANT IMPROVMENT REMODEL BUILDING USE: CI SFR El TOWNHOUSE D DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL APPLICATION INFORMATJON & DESCRIFTION,OFWORK CONTRACT PRICE OF WORK:$ 1500 !ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD (1) 50 AMP CIRCUIT TO EXISTING RELOCATED BOAT HOUSE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO El YES-Select Scope: 0 Service El Feeder f71 Circuits-#:1 0 Complete Re-wire LOW VOLTAGE WORK? El NO EYES-#of Devices: SELECT SCOPE(REQUIRED): Et Data Cl Intercom El Thermostat 0 Audio El Secure Access CI Security System 0 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. El Other(List All): 'OODE COMPLIANCE - •' IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACIUTIES: 711 NO Lj YES--See Below&Pg.2 I 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 Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO OYES-See Below&Pg.3 1---1 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I I 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 INFORMATION OWNER NAME: DALE WOODARD TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3726 BROADWAY STE 301 c,, EVERETT STATE WA zip 98201 OWNER PHONE:425-508-3079 'OWNER EMAIL:DALE@GAMU360.COM • - - CONTRACTOR NAME: ROBs ELECTRIC INC CONTRACTOR ADDRESS: STREET 4405 103RD AVE SE ary LAKE STEVENS STATE WA zip 98258 CONTRACTOR PHONE:425-334-6834 'CONTRACTOR EMAIL:MICHELLE@ROBSELECTRICINC.COM CONTRACTOR LIC.#(REQUIRED):ROBSEI*110D0 'CITY OF EVERETT BUSINESS LIC.#(REOUIRED):025145 PRIMARY CONTACT: DOWNER EICONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:I hereby certify that f have read and examined this application and know the same to be true and cormct All ntovLsions of laws and ordinances governing this type of work wilt be completed wnetner 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 perfotm the workfor which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAS. City of Everett Official Use Only PERMIT#: ,Pz, E 2 - 6b Owner/Authorized Agent Signature ' ._ .. "--- (Revised 1/11/2019) Page 1-Application