3430 16TH ST 2022-05-11 - Laserfiche WebLink

• • • ' sA �l ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINQ70N (P)425-267-aB10 I FAX426-257-6857 I(E)everottops@everettwa.govI xww.everettwa.goviparmIts PROJECTSITEINFORMATION PROJECT ADDRESS: 3430 -- 16th Street BUILDING AREA: 90° sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL :ELECTRICALAPQ cA. N'INFORMAT.IO.N'$r;DESCRIPTION'OF:WORK .. ASSOCIATED BUILDING PERMIT#(if applicable):CONTRACT PRICE OF WORK:$ e S SQ'� 2-0 CA DESCRIBE SCOPE OF WORK: add lighting, outlets, panel and feeder from existing service for new water testing laboratory THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope:0 Service 0 Feeder ❑✓ Circuits-#:1° ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑Intercom ❑ Thermostat ❑Audio El Secure Access ❑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,COMPIJANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ENO ❑YES--See Below&Pg.2 — By checking this box, I am stating that I have read and understand all of WAC 296-488-900,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 following sub sections that do not See Page 2 require Plan Review, ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LiCENSURE:ONO OYES-See Below&Pg.3 flPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I 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:'INF.A.RMATION: .. OWNER NAME: Gary Baldwin TENANT BUSINESS NAME(If Commercial):Washington Marine Cleaning OWNER MAILING ADDRESS: sTREET 3430 -- 16th Street ciTy Everett STATE WA z,P 98201 OWNER PHONE:425-508-9125 OWNER EMAIL:Gary@washmarine.com CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-508-9125 Gary Baldwin CONTACT EMAIL:Gary@washmarine,com AGREEMENT;I hereby certify Thal I have read and examined This application and know the same to be lure and correct Al!provisions of laws and ordinances governing this type of work will bo completed whether specified herein or not. The granting of a permit does not presume to give euthorily to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction, That I am authorized by the owner of this property to perforn?The work for which application Is made and! • comply th the State Contractors Lew 18.27 RCW and 296.200 WAC. City of Everett 0t11ole!Use Only 0' <-- PERMIT#: _ E n o -- ge wnar/Aultr g It Signature Date (Revised 1/11/2019) Page 1-Application