12830 19TH AVE SE 2022-01-21 - Laserfiche WebLink

rai •ECTRICAL PERMIT APPLOATION 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.gov I www.everettwa.gov/permits PROJECT SITE, INFORMATION PROJECT ADDRESS: Ic ..3O L / -e/?r.& /, f v ;L1letef BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: Li SFR TOWNHOUSE ❑ DUPLEX L ADU ] MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 2) 066,VD ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Ir¢ �1�` PcUie) j!)y) l,� + fa.r�f 5154 11'151��I1/�i -1,t5b �I 11 id.II t 1A IL Gl �71--�),(_S• '(-P�YY4. 1 A T�1 Auk c k• I 5 '�1 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO ❑YES-Select Scope: n Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? [ 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): 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 ❑YES-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: ��i jki YU1 h1 i -61144 / /y 1 TENANT BUSINESS NAME(If Commercial): Off() OWNER MAILING ADDRESS: STREET ic)'j Pr Str'44- CITY Sit STATE WA ZIP f OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: I(1\. i Si (1 L6' Ins-. CONTRACTOR ADDRESS: STREET g i-11 !q 1 s�4t. CITY W4'I 1 Vern56 STATE ZIP 9_ s,2.(3 CONTRACTOR PHONE: 3fj0 gag— 13a5 CONTRACTOR EMAIL: 10-017Is Cvm CONTRACTOR LIC.#(REQUIRED): inelerCL$34 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 513 to PRIMARY CONTACT: ]OWNER L_fCONTRACTOR LOTHER (Please Specify) CONTACT NAME: I CONTACT PHONE: 30 . 42M_ 1 /5 ". IAAo 1�. � �A CONTACT EMAIL: f cM1' c(Y l';�f' �1a V/1 , AG EEMENT:I herebycertifytha 1 have read and examined this application and know th same to be true and correct. All rovisidns of laws and ordinances governingthis � pP � p 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#: E2 ( o 1O3 Owner/ ut orized en Signature Date (Revised 1/11/2019) Page 1-Application