4509 CRESCENT AVE 2022-01-12 - Laserfiche WebLink

• 1151111 ® ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION 4 PROJECT ADDRESS: Ligaq cvesamtl.. IsW,e .40,41-WIFE lign12 BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ P3o©.°9- ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: i.K.SkOsAt .200 1 d - 46t,1C 4-. .p© PAT RckAre- THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ZIYES-Select Scope:X Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat El 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): 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: ❑NO 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: �0.101 ttns6+1 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 9SOO CfC 5 'E.s CITY STATE ZIP 92 ZO OWNER PHONE: OWNER EMAIL: WtA+1 .C . CONTRACTOR NAME: Mout'C.A.6 CONTRACTOR ADDRESS: STREET 2a 'iy ay,l y 4/�(J CITY l) i v1e.etc(�j� STATE \A {/•a ZIP 9,U 43 CONTRACTOR PHONE: CONTRACTOR EMAIL: � CONTRACTOR LIC #(REQUI ): CITY OF EVERETT BUSINESS LIC #(REQUIRED) PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT N ME: ` ,� a CONTACT PHONE: 360 -3 Lf _ 63 el L rL CONTACT EMAIL: l/y^%pi LvLS 're ,-1 y` 64/t. AGREEMENT:I hereby certify that I have read and examined this application and know the same to be tr d correcN 11 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. RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: �h ize%ge OwnerlAuthorized Agen ature Date (Revised 1/11/2019) Page 1-Application