3431 HOYT AVE 2021-12-17 - Laserfiche WebLink

MIN i S ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwa.gnv I wvwv.everettwagovlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 3431 Hoyt Ave BUILDING AREA: sq ft ,PROJECT TYPE: Cl NEW CONSTRUCTION ❑ADDITION ©TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ©SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION S DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1)CA). ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Add circuit for range hood. Add circuit for under sink garbage disposer. Replace knob and tube lighting circuits. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ©YES-Select Scope:❑Service ❑Feeder ©Circuits-#:4 ❑ Complete Re-wire LOW VOLTAGE WORK? © NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El 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): . - - -..... .. ,t.,., - CODE;COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: INO ❑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: ENO 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 OWNER NAME: Brian Moore TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS; STREET 3431 Hoyt Ave Everett STATE WA zip 98201 OWNER PHONE:425 232 1888 OWNER EMAIL:brian.moorej@outiook,com CONTRACTOR NAME: Brian Moore CONTRACTOR ADDRESS: sTREEr3431 Hoyt Ave on Everett STATE WA zip 98201 CONTRACTOR PHONE:425 232 1888 CONTRACTOR EMAIL:brian.moorej@outlook.com CONTRACTOR LIC.#tREQUIREO): CITY OF EVERETT BUSINESS LIC.#(REQUIRED}: PRIMARY CONTACT: ©OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT t hereby certify that t have read and examined tills 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 ofthis property to perform the work for which application is made and i comply with the State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only PERMIT#: 10/312019 E l Cc 2 — Owner/Authorized Agent Signature— Date (Revised 1/11/2019) Page 1-Application