926 MAPLE ST 2021-12-17 - Laserfiche WebLink

Nem • 4111 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 N N (P)425-257-8810 I FAX 425-257-8857 I(E)evereiteps@everellwa.gov www,e+.erettwa.gov/permifts WASHICTO PROJECT ADDRESS: Ci 7-4 1,../k t- veve,A4 49161)2-01 BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT [aREMODEL BUILDING USE: Pri SFR E]TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY tt OF UNITS: [7}COMMERCIAL : gI1IILCfRtCAL APPLICAflaWtNFO*MA1IO$&flESCRIPON OF WORK • CONTRACT PRICE OF WORK:$ tj 4,0 !ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: A G401 virt CAW veaftot nte v eak THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) UNE VOLTAGE WORK? Et NO Ed YES-Select Scope:El Service El Feeder A Circusts-#: I-- Complete Re-wire LOW VOLTAGE WORK? aNO El YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data El Intercom El Thermostat El Audio El Secure Access El Security System 0 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): COD PUMICE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: El NO LI YES—See Below&Pg.2 El 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 ElPursuant 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. MO; „ 'WV*, OWNER NAME: •fiellfl IV) TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 01% KA 91Pe, an, veve4 STATE kAjfq '1(Z,a0 OWNER PHONE: V\ A 'OWNER EMAIL: CONTRACTOR NAME: IN HOUSE ELECTRIC CONTRACTOR ADDRESS: mu-0 530 117TH DR SE cfri LAK STEVENS STATE WA .7,, 98258 CONTRACTOR PHONE:4257603203 'CONTRACTOR EMAIL:tHEPERMITS©GMAIL.COM CONTRACTOR LIC.#(REQUIRED):INHOUES952QG CITY OF EVERETT BUSINESS IX.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER DCONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 keisey CONTACT EMAIL:ihepermits@gmailcom AGREEMENT:thereby certify that I have and e nened this application and know the same to be aye end correct All provisions of/ ws and ordinances governing this type of work will be comp141 whether,,i h n 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 left const On or the an of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply Øh the ate C tractors taw Et RC end 296.200 WAC. City of Everett Official Use Only PERMIT#: /1/ iftVC31/ A 2:2Z / Owner/Authotized Agent'Signature Date (Revised 11/2019) Page 1-Application