1619 ROCKEFELLER AVE 2022-02-15 - Laserfiche WebLink

11111111 ® ELECTRICAL • PERMIT APPLICATION 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 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: \ �L� BUILDING AREA: sq ft� ��{K� ,-#�(°I (�'� �.�� PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT X1 REMODEL BUILDING USE: C SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION.OF WORK CONTRACT PRICE OF WORK:$ \3 i Boo ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: QG>`T j6 I 1 \(i o'b c rt e THIS INSTALLATION INCLUDES THE FOLLOWING,�/ SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO LJ.YES-Select Scope: ❑ Service ❑ Feeder Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? [ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑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: IO 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: �S S('\' \.)--k "'y TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 301 e,g Ail fs I L �je L✓ /\ CITY �i STATE( 'K , ZIP e'`l O /I OWNER PHONE S 1 I - 3`� . ,. OWNER EMAIL: p_t.�S,,eii +�.; _l\_.. 4 c e � j. )). .. or tek CONTRACTOR NAME: S--fJ41t( e-le( f-P/L- t-L. 0 /� CONTRACTOR ADDRESS: STREET 17 6 ) C) L✓a/d 4( V'% d r_ Sic �C�.M 1' 7 gD " L%y wit t ay � ,/ t:: CITYV" �1 1. + 11�+ STATE �,✓ ZIP _ ..Z CONTRACTOR PHONE: ,�C,1 Ci c%Gi 5 �-- CONTRACTOR EMAIL:VtL V/ ( 7S+i v L t`/.P('._, - • I. CONTRACTOR LIC #(REQUIRED) 54 nt I Zd 4 M4 CITY OF EVERETT BUSINESS LIC.#(REQUI D): Q I2 !_ WP " PRIMARY CONTACT: ❑OWNER [CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ` ,,<, c q G 5-7�I,L C1i�lC' \ Dr. C-i CONTACT EMAIL: • i 5 �'(/) I/ 1( r-Ct C <' /L1 AGREEMENT:I hereby certify that I have read and examined this application and know the same to true a 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#: G)__.; 1 2-1 Owner/A or' Agent Signature Date (Revised 1/11/2019) Page 1-Application