Laserfiche WebLink
011 <br />0 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERE-T T, WA 98201 <br />WASH ING ION (P) 425-257-8810 1 FAX 425-257-8857 i (E) everetteps@everettwa gov I www everettwa gov/oermits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 3614 FRIDAY AVE <br />BUILDING AREA: —sq ft <br />PROJECT TYPE: El NEW CONSTRUCTION Z ADDITION 0 TENANT IMPROVMENT [J REMODEL <br />BUILDING USE: W SFR M TOWNHOUSE [71 DUPLEX El ADU El MULTI -FAMILY - #OF UNITS:— [7COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORX: <br />CONTRACT PRICE OF WORK: $ 1000 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: <br />1 CIRCUIT FOR AC <br />1 CIRCUIT FOR CAR CHARGER <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? El NO [I YES - Select Scope: I] Service ❑ Feeder 10 Circuits-#: 2 El Complete Re -wire_ <br />LOW VOLTAGE WORK? NO F-1 YES- # of Devices: <br />SELECT SCOPE (REQUIRED): ❑ Data D Intercom [71 Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br />El 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 />EI Other (List All), <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO [I YES -- See Below & Pg. 2 <br />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 <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; NO 71YES -See Below & Pg. 3 <br />Pursuant to RCW 19,28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />IV4 without the proper electrical licensing and certification, or exemption. By rtecking this box, I any 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/certification requirement, <br />''* 1 77! 1 '77-7,7­7 'CONTIFUTF, <br />OWNER NAME: JORDAN PELL ETT TENANT BUSINESS NAME If Commercial): <br />OWNER MAILING ADDRESS: STREET 3614 FRIDAY AVE <br />,,, EVERETT S WE WA Z,,982010 <br />OWNER PHONE: 425-289-9335 <br />1OWNER EMAIL: JORDAN@SITE42. COM <br />CONTRACTOR NAME. N/A <br />CONTRACTOR ADDRESS: STREET <br />CITY ZIP <br />CONTRACTOR PHONE: ]CONTRACTOR <br />EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): <br />ICITY OF EVERETT BUSINESS LIC. #(REQUIRED); <br />.................... ­. ... ... ........ . <br />PRIMARY CONTACT: Z OWNER DCONTRACTOR [-]OTHER (Please Specify) <br />CONTACT NAME: <br />Jordan Pellett <br />CONTACT PHONE: 42 5-289-9335 <br />CONTACT EMAIL:jordan@site42.com <br />AGREPMEN r I hetaby certify that I have mad and examined this applkation and know the same to he true and correct. All provisions of taws and ordinances governing this <br />type of work wilt he rnmpleted t heft arspecified herein or not. The granting of permlt does not presume to give authority to wolate or cancel the previsions of any other stale or <br />local law regulatmg construction arthe performance of construction. That i am authorized by the owner of this properly to perform the work for which application is made and! <br />c,on7pjy veirh the State Contrar.M'rs Law 18. 27RCW and 296.200 WAC Ody of Everett Official Use Only <br />PERMIT <br />.. ..... .. . . . ... f�iziedi Agent Signature Me (Revised 109700,1 Page I-Apptication <br />