5505 OCEAN AVE 2022-02-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 5505 Ocean Ave, Everett WA 98203 1BUILDING AREA: 864 sq ft PROJECT TYPE: ❑ NEW CONSTRUC ADDITION ❑ TENANT IMPROVMENT ElREMODEL BUILDING USE: ❑✓ SFR ❑ HOUSE DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL ELECT CAL APPLIC TION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WOAK: New circuits for Recpti s and ' ting in addition and shop. (v t THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 4 ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: D NO 0 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 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: [I NO ✓ YES -See Below & Pg. 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rend, sale, or lease 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: Jim Kruse TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 5505 Ocean Ave CITY Everett STATE WA ZIP 98203 OWNER PHONE: 425-870-2754 OWNER EMAIL: )Irll_kruse@hotmall.com CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑✓ OWNER []CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Jim Kruse CONTACT PHONE: 425-870-2754 CONTACT EMAIL: jim—kruse@hotmall.com mumcciviciv is i nereoy cemry roar t nave reaa ano examined rnis application and Know the same to oe true and correct. All provisions of laws and ordinances governing this type of work will be completed whether 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 perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: IL40==� E Ro$.-oC40 Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application