11127 EVERGREEN WAY 2022-06-28 - Laserfiche WebLink

• • MIN ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINOTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits PYWOE INFA'... • ' ..� .,s,'',.j tv k„' . ,``: / PROJECT ADDRESS: / 1/ 7 � 7 ,. e , _Z.61,4 _ BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR El TOWIJ E ❑ DUPLEX ❑ADU El MULTI FAMILY-#OF UNITS: " COMMERCIAL ELECTR Si APPLI � INFORMATION DESCRIPTION OF WORK \ CONTRACT PRICE OF WOR $ - : C ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (2 ) 3 7J,, , co 74/A+ I (7) �-- THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 711-€S-Select Scope:❑ Service .E eder ❑ Circuits-#: 2— ❑Complete Re-wire LOW VOLTAGE WORK? Amp ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ 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):• ■. wY .�.�. , O afcOM ,VE ‘., IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: : 0 n YES—See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-90i,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: IlO 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. INI# RMrATI©N 11.. " � OWNER NAME: TENANT BUSINESS NAME(If Commercial): t C-IIOWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: po a�� CONTRACTOR ADDRESS: STREET 2.3 /% ,rl +, ( S 7— CITY " 'l j 7 G, �s. STATE „d'is ZIP CONTRACTOR PHONE:, C 7.9 ! 62500 I ONTRACTOR EMAIL: rk J ,4 C CONTRACTOR LIC.#(REQUIRED): i O4..1.2-...: .g. 3op?i/f EJCITY OF EVERETT BUSINESS LIC.#(REQUIRED): 3 3 L/Q PRIMARY CONTACT: DOWNER IACQNTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: c/-` C., 7 --3 � ? !.r� ��d/�r✓rt-/r� -F� CONTACT EMAIL: AGREEMENT.I hereby certify that I have read and examined this application and know the same to be true and correct. Al/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 -- ) PERMIT#: E noca ner/Authorized Agent Signature ate (Revised 1/11/2019) Page 1-Application