|
03/12/2020 09 : 57 #4694 P. 001/001
<br /> PERMIT
<br /> ELECTRICAL PEAPPLICATION
<br /> CtTY OF EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WA6HINeToN (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I wo.v.everettwa.gov/permits
<br /> M. X•r;4Yi'..)• {'?a{'9•'+�iSv !,�/$ ,. I• _ •.w, .:� __ __,;i r'' �� •�r "�a .;r "'«„'�^� �.u.,5.ii1JkF •r:�a.;'is�,.T.•hY.'[4'ftis.YL: ruqwN,�a„�l�`K 1
<br /> PROJECT ADDRESS: L 100th PI_SE BUILDING 1308 UNIT 1 BUILDING AREA: se ft
<br /> PROJECT TYPE: ❑ N C• STRUCTION ❑ ADDITION El TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE� ❑SFR 0 TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS:6 Ell CCOMMERCIAL�}��V.7.n• f' n .� � .' .:.v.r,:A1,^.,1 y, • ;aJ•'�. + � '. 1 7��. �'�., .:i6.:,'• • a .. &.J:raW��,•� wy' .; hee '�W!i�0.!W J, .ffJJ+.F4t9MP
<br /> i,� .Y,� :.�.'-•x:.:•LMw,n a «
<br /> CONTRACT PRICE OF WORK:$ 1700 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> RPLACE BURNT EXISTING INSIDE PANEL INSIDE
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) _
<br /> LINE VOLTAGE WORK? ❑ NO J❑YES-Select Scope: ✓❑Service Q Feeder ❑ Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio El Secure Access in Security System
<br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> ❑Other(List All)
<br /> w rV,.ti,eN.ay.f%A"if'..�;�;iV'••:wy.....:..,-......A,,�. ft, �tr�:. . �Nr r"�. •a"�/ 1'ik.': `.tl'G'••&^ �r•I{
<br /> �i,�� tn../5 �E��', '�'��:1�a,�w:;�;;i•�;,�.,s�:".�:�wvrtitw';d�t)1.,:;i';,yti�•.�..,, :� .-dt �r'�''+»w Ia.,�, r�'" J�:. a �,"' •it�'R�.! au�!,:'��`t'a�,,>�t�a,�.
<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: o NO • YES—See Below&Pg.2
<br /> ❑ By checking this box, 1 am stating that I have read and understand all of WAC 206-48B-900,selected the specific reason on page 2
<br /> of this application(soo next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: QNO OYES-See Below&Pg. 3
<br /> n Pursuant to RCW 19.28:261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease
<br /> without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that 1 have completed and
<br /> see page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement,
<br /> '.of r'r. ..,...., ax,�,:w.r,, .,,,..{. .., ...,::;R.r•:y+✓r::•.'<:!,.;,... 5.. „�,.., ..:r.-: 'M•,.-••('C!,,::.;+vsr,,,.rf,;: 'a•:^;. ,rtp.^R '"Y''' „r 6 ,vvwi •.d7<��;�'
<br /> �y�!7,.q�.,,�( `1•�,'°r, .t;Y;,v41ir;..it ,.!P.�yx,, ,Y.�71'h..a u•;;: h•',�;�:.;���r �,.�,� ....a :ai ,.r�qi.,..r. fu ,.t .�!�j ^'�, i),6„�t!`4y, .P �' 1 1' }��s �•3.
<br /> {L.Vln)�$".'r�,'Y��'},."1Y4,1� 'F% k�,. .1 t r:'Y.� Xul ���' Y ) 1 f.0 . �'•` r Y ,�i WI '1�$yl: ,rp o %' M T'l• ,7""i r A •.:.• N' ',A
<br /> R )f 4 ..le •�y.r..a.S.!' 'i'• .i�.1.=._y.�si;��.oad. &. e.' k','7�";
<br /> OWNER NAME: TRAILSIDE VILLAGE TENANT BUSINESS NAME(If Commercial)
<br /> OWNER MAILING ADDRESS: sTReET 1300 100PL SE#A
<br /> CITY EVERETT _ STATE WA aP 98208
<br /> OWNER PHONE:425.355.7119 OWNER EMAIL:
<br /> CONTRACTOR NAME: EYLANDER SALES& SERVICE
<br /> CONTRACTOR ADDRESS: smc£73601 EVERETT AVE
<br /> CITY EVERETT STATE WA ze 98201
<br /> CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL:iceylander@yahoo.com
<br /> CONTRACTOR LIG.#{REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS UC.#(REQUIRED):016363
<br /> -.,
<br /> PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) _
<br /> CONTACT NAME: CONTACT PHONE:425.231.2275
<br /> J C"N OT ME CONTACT EMAIL:jceylander@yahoo.Com
<br /> AG EE'MEN7;/hereby certify that I have read and examine tie application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> 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
<br /> !coal 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 1
<br /> comply with the e rectors Law 18,27 ROW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> /(J/-a E ^KOwner/ hertz A ent si nature `?_�
<br /> e 9 (Revised 1/11l2019) Page 1- pplicatiort
<br />
|