903 117TH PL SE 2022-05-02 - Laserfiche WebLink

® 0 r ILI ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 ( FAX425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 •- �( ._ ak _._ BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION R I ENANT IMPROVMENT ❑ REMODEL BUILDING USE: C SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ r..L (3c ASSOCIATED BUILDING PERMIT#(if applicable): i DESCRIBE SCOPE OF WORK: ( col C'', '1n• �cv\ shy x L.,, -1,1 c..ir�a �X 3 0., 1 Ok c K , )1-i./\-- C C-c . -r-- APC rtz J- ??s 1-R--L-hA%1 c Jct.-('C® ,-,c.' tt c S S-Alr 7 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO L-1 YES-Select Scope: El Service ❑ Feeder El Circuits-#: / El Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom El Thermostat El Audio ❑Secure Access El Security System El 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(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El 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 followin ub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO EYES-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. CONTACT INFORMATION OWNER NAME: ',, `;k c, j--�c (� ;,c--j. TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 96- ( 11 4-Li 9L. S.E CITY Ei.)'Z`=•k-"- STATE 4:r41\ ZIP NeJ OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: <<. ") l '�'/Cc ✓c(- L L C Ltd— CONTRACTOR ADDRESS: STREET I--t v ?c,KC `►d— crry ti f/`t t I4.,i STATE (AA A 1 ZIP 1 S'4 CONTRACTOR PHONE: J . �'� $"yi1, CONTRACTOR EMAIL: CONTRACTOR LIC #(REQUIRED) / h S� Z (-, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ON T ) PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) —Y> CONTACT NAME: CONTACT PHONE: COS-II -<y 3% f / > p `,c_i�,,c5-7-. CONTACT EMAIL: t' Cl X,`)C_`'. c----jeC:`tve C C L ,.L'-( , C `•.`z1 AGREEMENT:I hereby certify that I have read and examined this application and know the sahib to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whet r s ecitied 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 construction o the erformance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply ith the State ractor La' 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: E o7- 0/5 Owner/Autv_\ razed —rP ,y genTSicfnature ' Date (Revised 1/11/2019) Page 1-Application