2616 HILLSIDE LN 2021-11-12 - Laserfiche WebLink

. • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHING-0,z (P)425-257-8810 FAX 425-257-B857 (E)everettepsiteverettwa.gov I wwweverettwa.govfpermits " MititIORAtRIOAECWSIMIN ,• a:17 =, Es*Mtl PROJECT ADDRESS: 2.Coi CD If tSi e 1„,14,1rivt BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT El REMODEL BUILDING USE: tw.! SFR El TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: D COMMERCIAL 40:;:f°-1,&tj-,LMF,Cr:27Waji $ jLLj &D-Aaa,PTIO - "'"17',4ZOTIMITO.W"4- -n CONTRACT PRICE OF WORK:$ 1168 0 ASSOCIATED BUILDING PERMIT#(if applicable). DESCRIBE SCOPE OF WORK: „TYNSA.s. Sr 10.,Y PV '\/1 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) UNE VOLTAGE WORK? El NO [RYES-Select Scope:0 Service 2 Feeder El Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? RI NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data D Intercom 0 Thermostat El Audio El Secure Access 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): -„e IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES—See Below&Pg.2 E 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 UCENSURE: k14 NO DYES-See Below&Pg,3 — Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on •uildi gs 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. r,ft tO01414-2410117 ViiiCONWMPFAIONO1 VisOiCc OWNER NAME: c b 6.q,I Irent+ TENANT BUSINESS NAMEf Commercial): OWNER MAILING ADDRESS: STREET 2(1( (o Hi I1 1tt..n e CITY E ve rei+ STATE ZP 9 28-R OWNER PHONE: ZS- 355 1 ail OWNER EMAIL: rn-t-r-cn+(a)cot-Aegis+ . CONTRACTOR NAME: W e S 4-Cf"ri So p.. ,Ir‘C CONTRACTOR ADDRESS: STREET 40 41 1iror1/41. tIZ-J SA4..rie Pt CITY ..e U leto,not STATE WPS ZIP CI ZaZ C CONTRACTOR PHONE:3(0(,)" ltko• OSS`i 'CONTRACTOR EMAIL: C (1.41 CO 1A+1134vrtSts i CONTRACTOR UC.CREOUIRED):wESI I 671) CITY OF EVE-671 BUSINESS UC.#(REQUIRED): — - „PRIMARY CONTACT: DOWNER CONTRACTOR DoTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3(0D,14.6)... ocCi tbtvtI era,g1( CONTACT EMAIL: r 1„revta) Q ç -; AGREEMENT:I hefty certify that I have read and examined this application and know the same the true and correct All provisions of laws end 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 eat authonzed by the owner of this meetly 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 152_, PERMIT#: Owner/Authorized Agente Date r 1/ E ) 1 - (Revised 01/2019) Page 1-Application