1909 MONROE AVE 2022-02-23 - Laserfiche WebLink

EVERETT ELECTRICAL PF:RMI I APPLICATION rxvJtGT SITE INFORMATION PROJECTADDRESS: {Oq !V1-�'e taut, _ BUILDING AREA ' PROJECT TYPE: X NEW CONSTRUCTION 1....1 [-]TENANT ] TENANT IMPROWENT LJ RFb,ODFt BUILDING USE: ❑ SFR ----_-`- �] TOWNHOIISF __ DUPLEX PRICE OF WORK: SCOPE OF WOF BUILDING PERMIT # td app THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 9 YES - Select Scope: ❑ Service Yy Feeder f) Circuits-#:_LO_ ❑Complete Re -wire LOW VOLTAGE WORK? 4 NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ 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): _._._. IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO 71 YES -- See Below & P9. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-4613-900, selected the specific reason on page 2 ections That do not of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub s See Page 2 require Plan Review. kRE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: [4NO LJYES -See Below a se v9 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or le without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that 1 have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. R� TENANT BUSINESS NAME (If Commercial OWNER NAME:): OWNER MAILING ADDRESS: STREET 1v l a rG A4 (� �IJ`T srarE W t'l ZIP re_rt OWNER PHONE: OWNER EMAIL: _ j� e �3 a 5 eLLC- Na b e. , Z 4-f CONTRACTOR NAME: C 2 3o ad t o 5 �r ZIP q f3� 03 CONTRACTOR ADDRESS: STREET STATE CITY tl ) O� CONTRACTOR EMAIL: a�Z�-II? CONTRACTOR PHONE: � Z5 73-2 CONTRACTOR LIC. #(REQUIRED): C !� i)ZEE-,5 913l{ CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 5 PRIMARY CONTACT: []OWNER (CONTRACTOR=ER (PleS ecify) ase CONTACT PHONE CONTACT NAME: �q f CG �^ MU++keW � (� CONTACT EMAIL: ��Zef .IC certify that / have read and examined this application end know( same to be true and corcect. All provi ' Is of laws and ordinances f any other this AGREEMENT. I hereby rform the work for which application is made and I type of work will be completed whether spedtied herein or not. The granting o/ a pennft does not presume to give authority to violate oClt not lEverett the vt)fficlal Use Oiler state or focal law work regulatingbe construction he the performance of construction. That I am authorized by the owner of this propedy to pe PERMIT #: comply with the State Contractors Law 18.27 RCW and 298.200 WAC. E'� Lj (Revised 111112019) ' Page 1-Application Owner/Authoriz d Agent Sign re Da ONIddIHS }