2200 LOWER NORTON AVE 2022-03-23

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www,everettwa.gov/permits WASHINGTON :. PROJECT'S1TE'INFORMATION PROJECT ADDRESS: 2200 Lower Norton BUILDING AREA: 2400 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION 0 TENANT IMPROVMENT ❑ REMODEL -I BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY-# OF UNITS: ❑✓ COMMERCIAL ELECTRIOAL APPLICATION 1"FORMATIOR4 DESCRIPTION QF:WORK CONTRACT PRICE OF WORK: $ 1500.00 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Extend existing conduit and pull 3 new 120V circuits to an outbuilding to supply receptacle and lighting loads. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ✓❑ YES -Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:3 ❑ Complete Re -wire LOW VOLTAGE WORK? ✓❑ NO ❑ YES- # of Devices: �-1 SELECT SCOPE (REQUIRED): El 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 (bist All): e.. CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ 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 subsections that do not See Page 2 require Plan Review, __TT_ ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 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. 77 CONTACT INFORMATION a4. OWNER NAME: City of Everett TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 3200 Cedar St. CITY Everett STATE V V A ZIP 98201 OWNER PHONE: 425-257-8820 1OWNER EMAIL:kchriStiansen@everettwa.gov CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE. ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED). PRIMARY CONTACT: DOWNER []CONTRACTOR []OTHER (Please Specify) CONTACT NAME: Ken Christiansen CONTACT PHONE: 425-309-0470 CONTACT EMAIL:kchristiansen@everettwa.gov ,e n-1 —rect All provisions of laws and ordinances governing this AGREEMENT. I hereby certify that 1 have read and examined this appncauun an u h„mow « �� o - u ., u .................. • ••• r. _-- - . - - - 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 construcI194 or the parformance of construction. Thai I am authorized by the owner of this property to perform the work for which application is made and I comply wioorizedAgent rs Law 18.27 RCW and 296.200 WAC. City of Everett official Use Only PERMIT #: E ► (Z �5 whet/ nature Date (Revised 1/1112019) Page 1-Application