Laserfiche WebLink
NNE <br /> PLECTRICAL PERMIT APPLIPATION <br /> CITY OF EVFRETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET.EVERETT,WA man <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)evc/atopS4SEJVcruttwil.iicr IAAVw everettwa.gowpermIt. <br /> - % "'04sP174M710-Ftilimaltoto <br /> PROJECT ADDRESS. d LO I II" St- 86 435-4 BUILDING AREA.: <br /> PROJECT TYPE: Li NEW CONSTRUCTION 0 ADDITION LI TENANT IMPROVMENT [ 1 REMODEL <br /> BUILDING USE PI SFR Eli TOWNHOUSE El DUPLEX 0 ADU El MULTI-FAMILY- OF UNITS: fl COMMERCIAL <br /> ELECTFO .X-10NQN & I4ONk0 oRk <br /> CONTRACT PRICE OF WORK:$t,00 ASSOCIATED BUILDING PERMIT#(If applicable): ts) <br /> DESCRIBE SCOPE OF WORK: gtoo.ce two CUM 141 Fstw, rqu e_X 61i lekl nityl <br /> (Min iyokizo Fee-set- -tinierck , 044 v4lietola V10014 Ftin 60 awl a iocretil. SOcArli 141(1,11 Morizn <br /> NeY‘b l„Lakit E,viiii,c41 ;01 iti-aCh,. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ill YES-Select Scope: El Service El Feeder OCIredits-#: t El Complete Re-wire <br /> LOW VOLTAGE WORK? NO El YES-#of Devices:__ <br /> SELECT SCOPE(REQUIRED)._ El Data El Intercom El Thermostat El Audio El Secure Access U 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 far review of device location and installation approval. <br /> Other(List Ali): <br /> Ilk cbE cOMPLOINcE . <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: irti NO j YES--Sea Below&Pg,2 <br /> 1 By checking this box,I am stating that I have read and understand all of WAC 29e-46B-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 LICENSURE: gi%40 OYES-See Below Pg. 3 <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work or buildings for rent,sale,or lease <br /> 1"--- 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 /> '4AV' it COSTA:CT INFORMATIO, <br /> OWNER NAME: 11...littl Melovunit4,4 TENANT BUSINESS NAME(It commercial): <br /> OWNER MAILING ADDRESS: 11+1-I UW t 2:14 6t- <br /> crry eveyor STATE 'Mit ZIP (14b7..w6 <br /> OWNER PHONE: ‘426-404.• OWNER EMAIL: NI IA <br /> CONTRACTOR NAME: 1$10t. jj HCAAin23 AW <br /> CONTRACTOR ADDRESS: STREET 111 Le 22.04.% M SW <br /> crr(MOVvitlAir4- .rem-yr44.1. rwkoA),C ZIP <br /> CONTRACTOR PHONE: 1414-ill-iiSol CONTRACTOR EMAIL: vet Yet) loIoc 4,4-ryt czwl <br /> CONTRACTOR LICouIREf4 LtJ yc4c4t611 it.V. CITY OF EVERETT BUSINESS LIG..CREQuiRE0): (1041/2 <br /> PRIMARY CONTACT: r OWNER UCONTRACTOR nOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 14/5 141)41. <br /> 4-tv) M9tt CONTACT EMAIL: t,1 <br /> - <br /> AGREEMiNT: hereby c I Iwo rood wnl oxareirled this application and know the sakra <br /> cur*thisto be In arid comet Ad previsions at Paws and ordinances governing this <br /> 1}pu of wodetinN he completed whether treated herein or nor. The grauttngt of a pomtft does not presume to give authority to A'aleteorcmeet the proviatme of any offiel stale or <br /> beef few regokaing construdlon or the performance of construction. That tarn authorized by the owner of this prquarry to perform the work for which application is made and <br /> comply with the State Contractors Law 1&27 RCW and 2g6.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> E 10 o1 - <br /> Owrier1Author4ent Signature Date (Reviscd 1/11/2019) Page 1-Application <br />