6223 KENWOOD DR 2022-02-17 - Laserfiche WebLink

CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits -- ---. -- — .E'U'C1 c!'L-C' 1 9FIT �C 6�i! e VBC Rt #7? �r�✓/,v�0 (�� ` BUILDING AREA: sq ft P O ECT ADDRESS: p PROJECT TYPE: NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT G� REMODEL _ BUILDING USE: SFR © TOWNHOUSE 0 DUPLEX ADU ® MULTI FAMILY - # OF UNITS: 107 COMMERCIAL ELECTRICAL Eg�l; CONTRACT PRICE OF WORK: $ 1 S—C ASSOCIATED BUILDING PERMIT # (if applicable): UP-�C- DESCRIBE SCOPE OF WORK: 9C 6-AA4,A10 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORKS NO YES Select Scope:,m Service ® Feeder n Circuits-#: ® Complete Re -wire LOW VOLTAGE WORK? © NO YES- # of Devices: SELECT SCOPE (REQUIRED): Data 0 Intercom [3Thermostat ❑ 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): ODE 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, selected the specific reason on page 2 Elof 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: NO DYES -See Below & Pg. 3 ® Pursuant to ROW 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 si ned the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. See Page 3 9 Got - OWNER NAME: TENANT BUSINESS NAME (If Commercial): Gpiv�j"7� e4C�7c r ER MAILING ADDRESS: STREET STATE ZIP CITY OWNER PHONE: 7S- 3300 OWNER EMAIL: _ j CONTRACTOR NAME. VA'P��c�L o FLEMIA) T // F S CONTRACTOR ADDRESS: STREET 6v CITY �v ` 1`�� STATE Vv ZIP l CONTRACTOR. PHONE: D Z6 O-A l%/` CONTRACTOR EMAIL: W latC--Jr—1 L J� �� 0 o ' 1_.0 CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC #(REQUIRED). w PRIMARY CONTACT: ❑ OWNER KCONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 34o 2-6 ,5-- Sa d V 1TprL,1 y �' R CONTACT EMAIL: VPtQ Wit— F_C�iY�1� overnin AGREEMENT. I hereby certify that . have read and examined this Lip'tis oonof ad permit does not presume to give a authority to violate or cknow the same to be true and correct. All provisions ancel the provisions oaws and ordinancesf other state or type of work will be completed whetherspeci6ed herein Qrnot, . *@:g Pich local law regulating construction or the peftrmance of co true ion. That I am authorized by the owner of this property to perform the C ty of Eve eft official Use Onix and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT #: Date (Revised 1/1112019) Page 1-Applicatio Owner/Autgi..d t Signature 3