2220 MONROE AVE 2022-02-15 - Laserfiche WebLink

I • MEI LI 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 1 www.everettwa.gov/perrnits PROJECT SITE INFORMATION PROJECT ADDRESS: )-3-0 VViN<Dk.., I'\. <- BUILDING AREA: 0VQy sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT KREMODEL BUILDING USE: R.SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ U)t,UG's't' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: i..\f a;4Lt ht1,,%- �� ' �w j" �� VT�°� THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO El YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: 0' 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: 6NO ❑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: KNO 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 l� ,� -+ , TENANT BUSINESS NAME(If Commercial): OWNER NAME: �f f $ �;Jt �•-' q OWNER MAILING ADDRESS: STREET �L l9- 5 3�'t4 L. \A) rA_ ; ,,f�r� L `��f� i C' 3 to aro-t �/� `l lvr �' ( �IY STATEI �� ZIP r OW Jl ( , � OWNER PHONE: ��•-� l t 1 s 'OWNER EMAIL: � �,... CONTRACTOR NAME: At1S'C\i` !7:-`f..�c t CONTRACTOR ADDRESS: STREET i LS 0_S JOCC \.13 CITY AN-�4N9 kr)V\ STATE ZIP (C CONTRACTOR PHONE: CONTRACTOR EMAIL: 24 CONTRACTOR LIC.#(REQUIRED).AO I .1 ,I 'CITY OF EVERETT BUSINESS LIC.#(REQUIRED):05 0,3 [) PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) r r CONTACT NAME: CONTACT PHONE: (-(25 `l.el. O 2 ck CONTACT EMAIL: c `(+�� \ _ (- 0 - AGREEMENT:I hereby certify that I have read and examined this application and know the same to a rue and correct.horiAll lo provisions violate oro n s the and ordinances any other this or type of work will be completed whether specified herein or not. The granting of a permit does not presume to g Ye local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the wCitrk y for r Everett which application s ma is dy and I comply with the State Contractors aw 18.27 RCW and 296.200 WAC. PERMIT#: Ow erlAuthori d Agent Signature Date (Revised 1/11/2019) Page 1-Application