Laserfiche WebLink
0 <br />0 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 96201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everattepsCajoverettwa.gov, I www.everenvia,govipermits <br />FOJECT'OFTWJNFO <br />PROJECT ADDRESS, 5131 Dogwood <br />IBUILDING AREA: sqft <br />PROJECT TYPE. NEW CONSTRUCTION ADDITION D TENANT IMPROVIVIENT 0 REMODEL <br />BUILDING USE; SFR [7 TOWNHOUSE F-1 DUPLEX 13 ADU F1 MULTI -FAMILY - # OF UNITS: COMMERCIAL <br />-,,ELECTRICAL APPLICATION IN1FSRMATIO1!A,'.,, i _lESCRIETION, o P, <br />CONTRACT PRICE OF WORK: S 300 ASSOCIATED BUILDING PERMIT# (if applicabte): <br />DESCRIBE SCOPE OF WORK' <br />Install GFI exterior outlet <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ❑ NO YES . Select Scope: 1_10 Service 7 Feeder L7 Circuits -#; Complete Re -wire <br />LOW VOLTAGE WORK? NO YES- # of Devices: <br />SELECT SCOPE (REQUIRED); Data 0 Intercom 71 Thermostat 71 Audio 11 Secure Access Security System <br />Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional <br />Fire Alarm Permit is required for review of device location and installation approval, <br />Other (List All); <br />CODE COMPLIAO(CE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: J N47 YES — See Below & Pg. 2 <br />By checking this box. I am stating that I have read and understand all of WAG 296-468-900, selected the specific reason on page 2 <br />of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE; RINO [7YF_8 -See Below & Pg. 3 <br />Pursuant to RCW 19,28.261, property owners and leaseholders cannot perform electrical work an buildings for rent, sale, or lease <br />r_1 without the proper electrical licensing and certification, or exemption. By checking this box. I am stating that I have completed and <br />See page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/cenification requirement <br />..... . . ..... <br />777,7,,77%77 <br />OWNER NAME: Brian Earl TENANT BUSINESS NAME if Commercial): <br />OWNER MAILING ADDRESS: ...... 1, 5131 Dogwood Drive <br />Everett STATC, WA 2,, 98203 <br />OWNER PHONE: 425 633-7447 <br />OWNER EMAIL: <br />CONTRACTOR NAME: Boyer Electric Company Inc <br />CONTRACTOR ADDRESS: IT1111, 8119 240th St SW <br />Edmonds STATE WA zr- 98026 <br />CONTRACTOR PHONE: 206 367-7606 �CONTRACTOR <br />EMAIL: karen@boyerelectric.com <br />CONTRACTOR LIC. #(REQUIRED)- BOYER EC 1 OILE CITY OF EVERETT BUSINESS LIC. #(REQUIREDj: 22147 <br />PRIMARY CONTACT: []OWNER ZCONTRACToR LJOTHER (Please Specify) <br />CONTACT NAME: <br />Karen Hanso r�c'ONTAcT <br />i <br />CONTACT PHONE: 206 367-7606 <br />EMAIL. kareniMboyerelectric.com <br />AGREEMENT, I hereby canify mar r hiivmad and &xartunod this apoiCation *Ad know th,,arn, 1, be frileand correct, Aft piovisrOns Of laws and ordirentes governing fft <br />typo of work witl be compieled Mmlher specified herein ornat, Thogronling, of a pomt does not presurne, to 9410 authority to viointe or cancei the pm�ra'-Woris of any ether state o, <br />brat law regulating conalruction or the partotmance of construcher, That I am satharfead by the owner ofthis property to parlbim " ww* lot whkh aAotitation, is made and <br />cotishijr *91, Ow Slato Contractots Law 18.27 RCW and 296,200 WAC; CRY of Elftrott 04cial use Oh <br />PERMIT #:l <br />-4" <br />_JOA horl �..dAq,.t Igin.turis Date V—T— (Revised 1/1112019) ;Page 1-Application <br />