10906 3RD DR SE 2022-03-03 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www,everettwa.gov/permits WASH I NGTON Pit004140111.1611401004411014: PROJECT ADDRESS: D4210 2( 1)y" 61q2...0°3 BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT j2EMODEL BUILDING USE: AL SFR El TOWNHOUSE El DUPLEX El ADU 0 MULTI-FAMILY.#OF UNITS: (":COMMERCIAL ,A*L 1440rOCAILW , 1011Alr 061.A CONTRACT PRICE OF WORK:$ .40r) ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: CAVOW ftW DIVI,900A1 1/1÷ A-11124d _ THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ,,10 YES-Select Scope:0 Service El Feeder el Circuits-#: Complete Re-wire LOW VOLTAGE WORK? in NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): El Data 0 Intercom 0 Thermostat 0 Audio Ci 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): C ECOMPUANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: $ NO U YES—See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-46S-900,selected the specific reason on page 2 I._—. 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: ONO OYES-See Below&Pg.3 r-- 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. ,WSftqf:INi:-ViiL;,,COPteT. INOVROOMMtr OWNER NAME: .tyyTARAA ,40,001- TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1 VI OU go DIr \st cure F\Riviqt S-ATE Vic\ ZiP OWNER PHONE: OD OWNER EMAIL: Vih CONTRACTOR NAME: IN HOUSE ELECTRIC CONTRACTOR ADDRESS: sTREET1530 117TH DR SE Gay LAK STEVENS STATE WA zap 98258 CONTRACTOR PHONE:4257603203 !CONTRACTOR EMAIL:IHEPERM ITS@GMAILCOM CONTRACTOR LIC.#ifiEQUIRED):INHOUES962QG IEITY OF EVERETT BUSINESS tit.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER OCONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 kelsey CONTACT EMAIL:Jhoperrnits@gmaitcom 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 speak ein 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 perforcna construction, That lam authorized by the owner of this property to perform the work for which application is made and I comply wi tate Co9tractors Law lay/Ficw 296,200 WAC City of Everett Official Use Only PERMIT#: L::;7 E nA0 - -2:79 Owner/Authorized Agent Sighappe Date (Revised 14112019) Page 1-Application