2017 124TH PL SE 2021-11-09 - Laserfiche WebLink

• • E ELECTRICAL PERMIT APPLICATION CRY or EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 0tt201 WA6141N®TON (P)425-257-8810/ FAX.42>-257-8957 I(E)evereataps.everethua-gaga i www.euer .geWpermi$s ��.., r.,,., ,,.....� x......: ,k. ....sue tr ...., �. uk ..... �.. , ....... ,\�.. PROJECT ADDRESS: ZOt1 fli4t pt 6-e BUtLDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT F2"REMODEL. BUILDING USE: 4.SFR tJ TOWNHOUSE El DUPLEX El ADU ❑MULT1hFAMILY-#OF UNITS: 0 COMMERCIAL FORMATION CONTRACT PRICE OF WORK:$ i)DLP DO ASSOCIATED BUILDING PERMIT#(if applied:; o _ DESCRIBE SCOPE OF WORK: Wet, &we ffd fvfna-te SIPCT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO El YES-Select Scope:El Service El Feeder 'Gircuits4: El Complete Re-wire LOW VOLTAGE WORK? El NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): El Data: El Intercom PA Thermostat ❑Audio ❑Secure Access El Security System ❑Fire Alarm-Installations under this perliit 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) JR, .wANC Er IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO El YES--See Below&Pg.2 By checking this box,I am stating that I have read end understand all of WAG 250-46B-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: u NO EYES-Sea Below&Pg_3 n Pursuant I.o ROW 19 28.261,property owners and leaseholders cannot perform electrical work on buildings let rent,sale,or lease 1 without the proper electrical licensing and certification,or exemptIon.Sy checking this box,I am stating that I have completed and Sea Paps 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this lieens ngtoerlification requirement, OWNER NAME: 1)CIY IC3A + d, TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: wir e-t Uri itoctill Pt Se criy VATS vJ A z1O 9$'It 46 OWNER PHONE: 1p) ' otem OWNER EMAIL: 4Yl kr Vt1/42 iIc4►''t2 corelfoa GovYt CONTRACTOR NAME: Noe ROA WW1 T, i a' CONTRACTOR ADDRESS: srarcr 'll,llf "2-1—e41S ' raa '3I cm( 1"{:outl-ta,k. -Te r a.'t'.,1 arMs IA oliboAll CONTRACTOR PHONE:lot 111I-it' '1 CONTRACTOR EMAIL; V) I-A(.)0,-14014 ctifyinri-: corn ) CONTRACTOR LIC.#(REQUIRED): iJUJ e -Y i-1 e 2 1 lam- CITY OF EVERETT BUSINESS LIC # 9UIREDi 14O J) PRIMARY CONTACT: EIOWNER '$CONTRACTOR ®OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: tjL7,.11\ 11121 Pj1Ut., AwetY CONTACT EMAIL: byVilto t \Ala `r-i . ctl Y%fD+ Y' c,of '1 AGREEMENT':i hen y certify that t hew reed and examined this appik•ation and know the same to be true and correct_ Al!pnzvisien4 of lows attn.onl!eances governing tiita type of work Wn4 1.ie we/pieced whather specrhed herein ar nat. The granting of a permit does not presume to give authority to vin/ata or cancer the ptovis ens of any ewer state or boat fa W re alalhlg construction ear the per€orrrrance of con,simorion. That I art aaathaized by the owner of this property to perform the weak tor which opprIcalion is rnortc and i comply w*li the State Contractors Low-T.27RCW and=298200 W4C. City of Everett Official Use hilly ERMIT t .� 01, tot.1 \,Ct,od1 (1) Owner/A h !zed Agent Signature Data (RevtaedWI/2 liaj Page 1Appllcatlon