4728 DARLINGTON LN 2021-12-22 - Laserfiche WebLink

• • 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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT;SITE,INFORMATION PROJECT ADDRESS: '�7078 °ct,/ L BUILDING AREA: a sq ft PROJECT TYPE: CI NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT VREMODEL BUILDING USE: LJ 5FR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL.APPLICATION INFORMATION'&VERCRIPTION OF INOR,C CONTRACT PRICE OF WORK:$ 500 f?- (J0 ASSOCIATED BUILDING PERMIT#(if applicable): C/'f 0 L/— oU$ DESCRIBE SCOPE OF WORK: Fti l‘ v\0,4 r e (3o, e e e u.1.-.0 C+ C� (' t-f C_ t"l L !�C€ ///v l 1 c7 e /toe THIS INSTALLATION INCLUDES THE FOLLOyVING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? CI NO VYES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: Complete Re-wire LOW VOLTAGE WORK? l.e NO ❑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): CODES COMPLIANCE�` _. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: aNO ❑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 OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO ES-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 Pagef igned the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACTINFORMATION OWNER NAME:3-C t'IM.� e f k41t.{f TENANT BUSINESS NAME(If Commercial): k1 OWNER MAILING ADDRESS: STREET Li 7 9 Oc r\;✓u-+Ot^ L r" CITY Est L r e STATE Vv ZIP r1 Q yV OWNER PHONE: Z 5 7?C) ?C OWNER EMAIL: J � l� Vr`t • " e A-- ` Lc G nrr CONTRACTOR NAME: A)/ /4 CONTRACTOR ADDRESS: STREET l'-I '�] ` CITY ArI /T STATE Ali P ZIP Af// /- CONTRACTOR PHONE: /�✓-� CONTRACTOR EMAIL: Ai-/ C/- CONTRACTOR LIC.#(REQUIRED): A' I4 CITY OF EVERETT BUSINESS LIC #(REQUIRED) A//I4 PRIMARY CONTACT: [i 'OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: v CONTACT PHONE: �� 5 -7JC '2'oS.7 JL re_vy 1/(J 1h kc%LL1 CONTACT EMAIL: )�>t'L' i'Vly ,i..�C1v'1 kt.-:t47 '� t2k--te1, AGREEMENT:I heresy certify that I have read and examined this 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 of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: tf, L-i// � E C Own /Author' ed Agent Signature Date (Revised 1/11/2019) ( Page 1-Application 3 /)