805 103RD PL SE 2022-05-02 - Laserfiche WebLink

aim • • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASNINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everattwa.gcv I wvwv.everettwa.gov/permits Iskr„ PROJECT ADDRESS:'eCg I 03(61 f2 t, St. ..cAre--\A suiump AREA: sq ft PROJECT TYPE: DINEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 53 REMODEL BUILDING USE: SFR CI TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 1:7 COMMERCIAL CONTRACT PRICE OF WORK:$ 000 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 70 Ot fry ‘,, a-ArOie o eiv THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY), LINE VOLTAGE WORK? EE:s:11716 grYES-Select Scope: Service 0 Feeder 411 Circuits-#: 11 Complete Re-wire LOW VOLTAGE WORK? NO El YES-#of Devices: SELECT SCOPE(REQUIRED): CI Data 0 Intercom 0 Thermostat 121 Audio 0 Secure Access El Security System ID 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. 0 Other(List All): .4;ZZ:1g IS THIS P RMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO LI 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 followin sub sections that do not See Page 2 require Plan Review. ARE YOU N OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ElNO DYES-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. frt. Afav OWNER NAME: i\A014,Vve,N6 (ro I TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET Q2C0 103reA PL. (11 STATE INA ZIP 4;1 Cb 2-0 t OWNER PHONE: V\I 04— lOWNER EMAIL: tA CONTRACTOR NAME: Lick .kei-ovkG-e ?1r.„64-v- c„, CONTRACTOR ADDRESS: sTRegT 106o cr, tt. S't-cisTAIS STATE W A z,p MZ2000 CONTRACTOR PHONE:L- 7L 1 Q0 32,0 ICONTRACTOR EMAIL; W10i0eXiMiTS 6) nrial •6001 CONTRACTOR LIC.#(REQUIRED): o1„Dk..,rf, tstsz:c.5L1EtTy OF EVERETT BUSINESS LIC.#(RECUIRED):00--1 1, (..19 PRIMARY CONTACT: DOWNER ErCONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: a-2,s 2.„0 ‘71 LA CONTACT EMAIL: hpyi jereiv tivik T p ,ot AGREEMENT:I hereby certify that I have read and examined this application and know the same taletnie and correct. All provl‘ns of laws and ordinances governing this type of work will be comp ted 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 ulating c9nitnictlon 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 ply wi the SØ Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 2-0 41,0 7,-0 EZool- \\ CO er/Au orized AgentS4ture Date (Revised 1/11/2019) Page 1-Application