Laserfiche WebLink
LLECTRICAL PERMIT APPLOATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE I I,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov www,everettwa.goviperrnits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2-1 Cct 16,,e, .BUILDING AREA: 5 00 sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION 1:1 TENANT IMPROVMENT ki REMODEL <br /> BUILDING USE: D SFR El TOWNHOUSE 0 DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION Sk DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ I -2,0 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: slke 0.1 140) La. r r t r -,zeicieee teZ <br /> -1- u1/4" <br /> 1/4)t r- <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ,,f3.1 NO El YES-Select Scope:El Service 0 Feeder El Circuits-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO EYES-#of Devices: So <br /> SELECT SCOPE(REQUIRED): Data 1:1 Intercom 0 Thermostat 0 Audio El Secure Access l 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 /> El Other(List All): <br /> CODE COMPLIANCE <br /> , . <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 7-1 NO ( YES—See Below&Pg.2 <br /> F7< By checking this box,I am stating that I have read and understand all of WAC 296-4613-900,selected the specific reason on page 2 <br /> of this application(see 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 UCENSURE:LINO DYES-See Below&Pg.3 <br /> 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 I 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 /> CONTACT INFORMATION <br /> OWNER NAME: cry ficA/kx,,t_z, Orf;,I-0,1( TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: seT <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> • .CONTRACTOR NAME: (.4)vt-.A.pe-v•"1 <br /> CONTRACTOR ADDRESS: sThEET 9CS1 S(A) 413, :Lc <br /> CITY k‹..E.APkt.).n. STATE ‘..A)A tre6 5'7 <br /> CONTRACTOR PHONE: Z°6 0(.5 CONTRACTOR EMAIL: r;L- - ( - c 'e( tcCO <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER ECONTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: --Lc <br /> 14: <br /> CONTACT EMAIL: r u c .1 . <br /> AGREEMENT I hereby certify that have read and examined this application and know the same to be two and correct. 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 /> local law regulating construction or the performance of CCIPStructon. That lam authorized by the owner of this property to perform the work for which application is made art <br /> comply with the Stale Conlracto9 Law 18.27 RCW and 298.200 WAG City of Everett Official Use Only <br /> PERMIT#: <br /> 44 - 3 - 11 E 1,0t 0(4 - cs-zp <br /> OwnerlAuthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />