2130 LOMBARD AVE 2022-03-23 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1 FAX425.257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 2130 Lombard Ave BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ TOWNHOUSE ❑ DUPLEX ❑ AD ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL �iS■FFR �� -� 3r - I CONTRACT PRICE OF WORK: $ 2000 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Install 200 amp main breaker panel THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: ( CT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scop : ✓ ervice ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ 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): IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: LJNO LJ 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: 7 NO ❑YES -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. Wo 77. OWNER NAME: Kaelin Newman TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET 2130 Lombard Ave CITY EVERETT STATE WA ziP 98201 OWNER PHONE: 425-205-8703 OWNER EMAIL: kaelin_newman@yahoo.com CONTRACTOR NAME: PARKER BROS ELECTRIC CONTRACTOR ADDRESS: STREET 13630 54TH DR NE CITY MARYSVILLE STATE • ��/�� A Z,P 98271 CONTRACTOR PHONE:425-239-6319 1CONTRACTOR EMAIL: GARY cI DPARKERBROSELECTRIC.COM CONTRACTOR LIC. #(REQUIRED): PARKEBE845NT ICITY OF EVERETT BUSINESS LIC. # REQUIRED : 56709 PRIMARY CONTACT:. ❑OWNER [!]CONTRACTOR ✓❑OTHER (Please Specify) OFFICE ADMIN CONTACT NAME: Natalie CONTACT PHONE:360-572-0108 CONTACT EMAIL: admin@parkerbroselectric.Com �— - - • ..u— r emu. y rrrar r,a> roav aria vAarrurvcu ruts cpprrcurrun unu nnow ure same to be True ana correct. An provisions or taws 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 #: 41 10/24/2019 E i O� I( () 10 Owner/Au horized Agent Signature Date (Revised 111112019) Page t-Application