628 61ST ST SE 2022-01-24 - Laserfiche WebLink

az CTRICAL PERMIT APPLIAPTION 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: 628 61 St ST SE BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 5000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: MOVE METER BASE AND ADD NEW SERVICE PANEL. REFEED EXISTING PANEL INSIDE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ✓❑YES-Select Scope: 0 Service ✓❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio ❑ Secure Access El Security System El 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 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: ROD & SARA LAZZ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 628 61ST STREET SE cn, EVERETT STATE WA ZIP 98203 OWNER PHONE:425.355.71 19 OWNER EMAIL: CONTRACTOR NAME: EYLANDER SALES & SERVICE CONTRACTOR ADDRESS: STREET3601 EVERETT AVE oily EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL:1Ceylander@yah00.00m CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363 PRIMARY CONTACT: OWNER CON RAC OR ❑O T HEK(Please Specify)fy) CONTACT NAME:J C N OTM E CONTACT PHONE:425.231.2275 CONTACT EMAIL:jceylander@yahoo.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 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#: __�-- 3 /z E b 3--(AID Ow o zed Agent Signature ate (Revised 1/11/2019) Page 1-Application