315 E CASINO RD BOOST MOBILE 2021-12-16

E •ECTRICAL PERMIT APPLIFATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 W A S H i Pc G F O N (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps everettwa.gov I wwweveteitwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 31 5 C C45 i no Pa �fe., I- BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ®TENANT IMPROVMENT ❑ REMODEL BUILDING USE: C SFR ❑TOWNHOUSE ❑ DUPLEX Li ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 8 5 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: In S*cx‘\ ( ) LID SOU C C ,1 skp I a, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 5i,NO El YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO 5Z YES-#of Devices: ( SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ 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): SCA rl CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO ❑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:"lNO EYES-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. CONTACT INFORMATION r1 OWNER NAME: TENANT BUSINESS NAME(If Commercial): (76-1- Old ji )e_ OWNER MAILING ADDRESS: STREET o j 5 .(✓ (cc...,i n r7 -E' CITY V\J(j I+ STATE v.} A- ZIP CI 2 0 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: P) C I 5k cy) r v IC-f S CONTRACTOR ADDRESS: STREET ih '2 ' '11 - E' rc-H-_ W' E2___. 1 CITY m 1 G'ee I� II�^, STATE �A- ZIP 9 OO j 2 CONTRACTOR PHONE: -4 2 5.3 30, .Si by CONTRACTOR EMAIL: L)(a S (C)l.3 141 S f . C C V) CONTRACTOR LIC.#(REQUIRED): t R j b(S -5i4 9 9c.)Pt? CITY OF EVERETT BUSINESS UC.#(REQUIRED): 0 5 S 10 PRIMARY CONTACT: DOWNER CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: Iran K, CONTACT PHONE: 2 of 33 O, a) b C) r ' CONTACT EMAIL: bb-i-S)Gt n.) /n 3 n . CO'y'y�J AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and o i_nances 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 properly to perform the work for which ch application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Owner/Autho ' d errt gnature D to (Revised 1/11/2019) Page 1-Application