3921 FRIDAY AVE 2021-11-17 - Laserfiche WebLink

• ELECTRICAL PERMIT APPLIC TIO' CITY OF EVERETT PERMIT SERVICES O'hr 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits PROJECT SLL["fE;INEORiVfAT1AN„ ;' PROJECT ADDRESS J 9 z J F, i , , C�L/eieA' (BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ADDITION ®TENANT IMPROVMENT ® REMODEL BUILDING USE: FR 0 TOWNHOUSE ®DUPLEX ®ADU 0 MULTI-FAMILY #OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8� )IeECRIPTION,OF'WORFt,, CONTRACT PRICE OF WORK:$ r) [ r (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: e - S , SCE✓v - CL iti THIS INSTALLATION INCLUDES THE FOLLO ING SCOPE: (SELECT ALL THAT APPLY)r LINE VOLTAGE WORK? 0 NO YES-Select Scope: 1,a Service El Feeder ® Circuits-#: ®Complete Re-wire LOW VOLTAGE WORK? EJ NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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:COIVPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: L:J 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: riNO OYES-See Below&Pg. 3 ® 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. • OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITYSTATE ZIP OWNER PHONE: (OWNER EMAIL: .,._, CONTRACTOR NAME: 7 CONTRACTOR ADDRESS: STREET /j / / a C C/ p/T (_CITY y ([//J STATE ZIP qc c , CONTRACTOR PHONE: - 2< - S Z 4CONTRACTOR EMAIL: La&rt'L(mil-e _ 9,4 (40, /4/t..0 b CONTRACTOR LIC #(REQUIRED) (- C 4 ....L 72_ (CITY OF EVERETT BUSINESS LIC #(REQUIRED): pj . -}7) I'SsW-e PRIMARY CONTACT: ❑OWNER 'CONTRACTOR ❑OTHER(Please Specify) pe4 my' e U CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be 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 C wr k for Ewhieht Opic lica atil n s madl is e and comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT#: er: 6- E t '9 D 3 t(02.. Owner e Agent Signature Date ` (Revised 1/11/2019) .. Page 1-Application