Laserfiche WebLink
Dec31 19 04:27p Bob Jack .096746777 p,1 <br /> • <br /> 7 ELECTRICAL PERMIT APPLICATVI <br /> CITY OF EVERETT PERMIT SERVICES <br /> _ .if 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX ((E)everetteps@everettwa.gov( v.ww.evorettwagov/permits <br /> .Y <br /> PROJECT ADDRESS: ,/5 J /13 S_f' . •r• BUILDING AREA: /6 %G sq ft <br /> PROJECT TYPE: O NEW CONSTRUCTION ®ADDITION O TENANT IMPROVMENT ErREMODEL <br /> BUILDING USE: O SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU D MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> :.:ELECTRIC:." : :: : CATION ANFORMATION 1 ;DESCRIPTIIoN®E 1 VOR1 <br /> CONTRACT PRICE OF WORK:S 2-_e' ASSOCIIAATED BUILDING PERMIT tf if applicable): <br /> DESCRIBE SCOPE OF WOR : �:}/j Si-t4/1 Aj ,: -f I L C'c'd cr'144 I? _r-44)r•f If-? C: :r d. -N-e S . <br /> t 7s <br /> Oj <:1).e,A, -', r.-- r•_c t 1,4-azi.1 elk k) ti?el, C-P6-i\-1) <br /> THIS INSTALLATIION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:0 Service 0 Feeder ®Circuits-#: ®Complete Re-wire <br /> LOW VOLTAGE WORK? , 0 NO ES-#of Devices: {I, <br /> SELECT SCOPE(REQUIRED): Data 0 Intercom 0 Thermostat 0 Audio Secure Access ®Security System <br /> 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 /> 0 Other(List All): <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: O -0 YES--See Below&Pg.2 <br /> El Bychecking this box,I am stating that I have read and understand all of WAC 296-46E-9D se cted 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 fallowing 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: 0 OYES-See Below&Pg.3 <br /> ® Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on b ildi gs 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/cerfific qurremen <br /> c c 2.GON'TAGTINEORIVIA'1rION ` <br /> OWNER NAME: T. .. {- lAAt. c,-yj-? TENANT BUSINESS NAME(If Commercial): - :.::ex_r.4-cri <br /> OWNER MAILING ADDRESS: STREET 1 '--7-- f 1,2.- - <j. - <br /> CTY E-i-rr>/--e- &-e--- STATE (.� y-t . 27P 'ZC <br /> OWNER PHONE: OWNER EMAIL: \\\ <br /> CONTRACTOR NAME: �f- :..t. ?. 01 - <br /> CONTRACTOR ADDRESS: STREETS 1-13 S At, ,e, ,=ice. fl G C <br /> em 1 I�-t a -,F STATE 1' r z,P i 23.12 <br /> CONTRACTOR PHONE: Spy 6G j 35 eL ic !CONTRACTOR EMAIL: S '�k k-E ql 1,45e C e =.ere. .-. <br /> CONTRACTOR LIC.tl(F2EQUIRED): g CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Ci7 if- 4 <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: )i .g7 13 i7 9 <br /> 7-7 tk,, �_ /' CONTACT EMAIL: i_< 4 I 4.L /'`/j <br /> AGREEMENT:1 hereb certify that I have read and examined this application and know the Same to be true end correct. All provisions oflaws and ordinances governing lids <br /> type or work WI a comp d 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 stale or <br /> local law re Ming cons1ru lion or thelperformance of construction. Thal I am authorized by the owner of this property to perform Ore work for which application Is made and 1 <br /> comply w' the State Con ctors 1. 18.27 RCW and 206.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> / . <br /> . / i 7 E 10\1- \q <br /> Owner/Alit on ed Agent Sig ature ate (Revised 1/11/2019) Page 1-Application <br /> i <br />