4027 4TH ST SE 2022-05-24 - Laserfiche WebLink

— • 1121 ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits i`PROJECT SITE INFORMATION .. PROJECT ADDRESS: 4027 4th St. SE BUILDING AREA: 20000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ✓❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL u ELECTRICAL APPUICATION'INFORMATION.&..©ES RIPTIoN 0.FAAJORK g CONTRACT PRICE OF WORK:$ 2500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Add 480V 3-Phase 20A circuit for new dishwasher. Re-purposing existing circuit, pulling equipment grounding conductor, adding 60' of me cable, adding equipment disconnect, installing conduit to dishwasher THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO E YES-Select Scope: ❑Service ❑ Feeder E Circuits-#: 1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ 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): CODEAOMPLIANCE ' , IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: tHl NO 1YES--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 following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg.3 111 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 INFORMATIONS :... OWNER NAME: City Of Everett TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3200 Cedar St. CITY Everett STATE WA Z,P 98201 OWNER PHONE:425-257-8820 OWNER EMAIL:kchristiansen@everettwa.gov .....__......................._........... CONTRACTOR NAME: City of Everett CONTRACTOR ADDRESS: STREET 3200 Cedar St. CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE:425-257-8820 CONTRACTOR EMAIL:kchristiansen@everettwa.gov CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-309-0470 Ken Christiansen CONTACT EMAIL:kchristiansen@everettwa.gov AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed 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 law regulating construction 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only e/7 PERMIT#: 2/8/2020 E Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application