1127 74TH ST SE 2022-03-04 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT,WA 98201 wa srriNcrort (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@"everet!wa.gov I www.everettwa.gov/permits PROJECT S ITE INFORMATION PROJECT ADDRESS: 112:7 1 L/1- 1`r` tf G" JVe../{.±-- 9)2.02) BUILDING AREA: ry sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT REMODEL BUILDING USE: E SFR El TOWNHOUSE El DUPLEX ❑ADU MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 'ELECTRICAL.APPLICATION INFORMATION...$ DESCR$p1 O N F WOR CONTRACT PRICE OF WORK:$ !CVO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: L �-- c c(Mi r -you I I) c(4,41 is ots THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPL) LINE VOLTAGE WORK? ❑ O YES-Select Scope:E] Service El Feeder Circuits-#: A- CI Complete Re-wire LOW VOLTAGE WORK? 1 I NO D El YES-#ofDevices: iCeS: SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El 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): • IS THIS ERMIT EDUCATION, INSTITUTIONAL HEALTH AND/OR PERSONAL CARE REFACILITIES: 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 Y 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 INFORM iTIOI OWNER NAME: I,'Yi t tlj") ,,cv-veairct TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: STREET m ,K,/11.21�'/�t�_k t(t} St '��a Q� /� c 'W l� 'V' STATE VVA zIP l)ZO72 OWNER PHONE: Vt.,1 (A OWNER EMAIL: '`l y CONTRACTOR NAME: IV\ - 1,1\4-e \ -_t r't CONTRACTOR ADDRESS: STREET \ .3.0 C41��y(� /"1p,D1' kCE (�_ �1 ,J l CA C4 1$ STATE ,� A zip lag 2 V CONTRACTOR PHNE:42- I.Q 0 '5 2.43 CONTRACTOR EMAIL: i I�Q E rY' ' ' -,,Li). ( �f J , v�i CONTRACTOR LIC.#(REQUIRED):k (`1 k O S r1 (- CITY OF EV RETT BUSINESS LI .#(REQUIRED): U l PRIMARY CONTACT: t52 WNER L�tt.:ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: i 7 t, % q i t.,t CONTACT EMAIL: 1 1Ir }J,pe4 in ms t0 } l. t�tr )`(j),-�� AGREEMENT.i hereby codify that 1 have read and examined this application and know the same to be true and correct. All Q,,>f ovisions of laws and ordinances governing this type of w ill be comp/ ted 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 layt reg feting constuction or the performance of construction. That't ern authorized by the owner of this property to perform the work for which application is made and I corytiy with he State Contractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only PERMIT#: - .1,3(.2-0 2---0 E 2 oZ' OCS Owner7Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application