922 51ST ST SW 2021-12-23 - Laserfiche WebLink

AIMS E4111ECTRICAL PERMIT APPLeTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 922 51st Street SW, Evertt, WA 98203 BUILDING AREA: 144 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ri:/1 ADDITION n TENANT IMPROVMENT U REMODEL BUILDING USE: SFR ❑TOWNHOUSE ❑ DUPLEX Li ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Extend existing bedroom duplex outlets into addition; extend existing bedroom heater into addition; and extend existing ceiling light into addition. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: n Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑ YES-#of Devices: SELECT SCOPE (REQUIRED): ❑ Data Intercom ❑ Thermostat ❑ Audio ❑ Secure Access n 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. ir I I Other(List All): 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: ENO RYES IYES-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: Thomas Hutchinson TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET POB 2230 CITY Everett STATE WA ZIP 98213 OWNER PHONE:425-252-0890 OWNER EMAIL:n7pkk©hotmail.com CONTRACTOR NAME: OVVIALP CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: VIOWNER Li CONTRACTOR (OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-0890 Thomas Hutchinson CONTACT EMAIL:n7pkk@hotmail.com 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 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 1 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#: I lank, �; - 671 l 1— E 2_001-• \ D Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application -3