7808 BEVERLY BLVD 2021-11-10 - Laserfiche WebLink

• ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 W4SFONGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov t www.everettwa.gov/permits PROJECT SITE ;.:;W:474: PROJECT ADDRESS:--ThVOb P,e oefi i2?CIGivcArc.44- 01%1,03 BUILDING/AREA: sq ft PROJECT TYPE: 0/NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT REMODEL BUILDING USE: LIESFR El TOWNHOUSE El DUPLEX CI ADU El MULTI-FAMILY-4 OF UNITS: El COMMERCIAL CAL APPLIC: CONTRACT PRICE OF WORK:$ 01 OD ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: i0 Ct 1-0 04°Sett THIS INSTALLATION INCLUDES THE FOLL?WiNG SCOPE: (SELECT ALL THA PLY) LINE VOLTAGE WORK? 0O 'EYES-Select Scope: El Service El F der le Circuits-#: Complete Re-wire LOW VOLTAGE WORK? NO El YES-#of Devices: SELECT SCOPE(REQUIRED): CI Data El Intercom El Thermostat El Au El Secur cess 0 Security System El 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I) NO U YES—See Below&Pg.2 E By checking this box, I am stating that I have read and understand all of WAC 296-48B-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 followi sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: Eo OYES-See Below&Pg.3 E Pursuant to RCW 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACTINFORMATMV,„ < , OWNER NAME: 1`,..A 41.14-- 7,0"‘ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1 t0(20 \Idt CITY vv64( ft. STATE IA A zlic610 OWNER PHONE: 11\j OWNER EMAIL: IN- CONTRACTOR NAME: VA tlekvIc/ CONTRACTOR ADDRESS: STREET )0 13 11111A " f• ce cay 1,0‘.1t-e -rcArovts STATE Wit- ZIP 1E62° CONTRACTOR PHONE: A45 1Op $"2'473, CONTRACTOR EMAIL:iki\ArtierviA-tc (2 al 1,ra...A . Caryl CONTRACTOR LIC.#(REQUIRED): I NI ttOVIC5(71U2.061 CITY OF EV REIT BUSINESS LIC4(RECIUIRED): OLI/LAI 142 PRIMARY CONTACT: [DOWNER ECONTRACTOR nOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /-1/2. • 2,0 ,Nk-tat .124c CONTACT EMAIL: te-eAGN®, YINAASe'CA et-1-60 • Co6len AGREEMENT:I hereby certify that I have read(i7nd ex mined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will ompleted whether specifie herei o I. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law re acing onstructi or the performInce a onst ction. That I am authorized by the owner of this property to perform the work for which application is made and! comply the St te Cant tors Law 18.27 FTW n 296 00 WAC. City of Everett Official Use Only PERMIT#: E - S3 Owner/A orized Agent Signature Date (Reosed 1111/2019) Page 1-ApplIcation