524 75TH ST SE 2022-03-04 - Laserfiche WebLink

• 0 .,�.. ELECT:'ICAL PERMIT APPLICATI•N CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: SO,4.4 ‘ + Si-,t.- BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION /TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: it COMMERCIAL !#TION i PE SCRIPTIQ$O ' Rt E�.EC4t�t�'�ii� A1P�PLtCAT[Gt�f �O�I,1 _. .CONTRACT PRICE OF WORK:$ qv 00 ASSOCIATED BUILDING PERMIT#(if applicable): ❑ I `le?-7-60 4 f DESCRIBE SCOPE OF WORK: �ticl 1 u^pc 4.,r. I t 'C '- 6 id. >i cLu- P. in Oil 47ck. 7...-ita 1(1P `c hctc. d t,'r . 1 o I - . :THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) t : Iram LINE VOLTAGE WORK? t�� I IO ❑YES-Select Scope:ElService ElFeeder El Circuits-#: CIComplete Re-wire LOW VOLTAGE WORK? ❑NO rr r ES-#of Devices:_ SELECT SCOPE(REQUIRED) ❑ Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El Security System Fire Alarm Permit is required for review of device location and installation approval. El Other(List All): ='` CODE*C,QMRUANCE °,tt ~, ,` , IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO I. ES--See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-46B-900,selectee he 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 I ' See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: lT NO EYES-See Below&Pg.3 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on• il.ngs 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. OWNER NAME:-nte Tecrateel i3ever L(LakiENANT BUSINESS NAME(if Commercial): ileaace Jai- geverty / t :„/ 7-� �<"%. vie OWNER MAILING ADDRESS: STREET (�jg°,jam Jp(� clr �� 2✓r a STATE ZIP V OWNER PHONE: q?5%- y$'_s$ OWNER EMAIL: ei t)�T" r�" + t�e- (t ( 2,63 °can, CONTRACTOR NAME: it k�cc Ate rYYL$f rie j CONTRACTOR ADDRESS: STREET l CI Z3 --4(1, Ave iV 51,e. � j�" CITY / I t STATE f p J 3 ZIP p g 8 O 3 4 CONTRACTOR PHONE: It -- en - ( �Q CONTRACTOR EMAIL:� (bike. ties if Pa . o5Olvilo i5. GI CONTRACTOR LIC.#(REQUIRED):Ag,5C it I ZZJEs iCITY`OF EVERETT BUSINESS LIC.#(REQUIRED): O t/354,z. PRIMARY CONTACT: ❑OWNER SZOONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: iz . ?j III.(ip c- JN. ul lri A5 y f e CONTACT EMAIL:till e . a S pn> ,1trt10 is tow l AGREEMENT i hereby certify that I havread and examined this application and know me to be true and cdrect. 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 Jam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contract rs Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 1 -^ '' //0/1/47 , _ E 60 4- - \,0 k , Owner/Auth zed A ent Signature Date (Revised 1/11/2019) Page 1-Application