8530 EVERGREEN WAY FRED MEYER 2022-10-06

Jul 13 19 04:19a Bob Jack • 1.6746777 p.1 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 P!! vnvw.everettwa.govtperm[ts "� (P)425-25T-8810 1 FAX 425-2b7-8857 i(E)everetteps@everettwa.gov{ , �a'� I�y�_ �• fop ®p��y ` �f- �r t l,PlaO Ed.rfSY FRII Q__5117�p+t' RO_`_, _ . PROJECT ADDRESS: 3 p�� lljer.L.,f~pr Welk/ BUILDING AREA: 'vet.; _soft PROJECT TYPE: ®NEW CONSTRUCTION ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE 0 DUPLEX O ADU 0 MULTI-FAMILY-#OF UNITS: - MERCIAL ELECTRIIONL;APB,PLICATiON INFORMATIONA gScRu TIEOAPF! Ol ; ._ CONTRACT PRICE OF WORK:$ r, N ASSOCIATED BUILDING PERMIT#(if applicable): • DESCRIBE SCOPE OF WORK: j Ate`.; pp eE%it G+ -T-.- -_b rf^ C . ^ A-(SsPS. '[^� I THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:O Service 0 Feeder 0 Circuits#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO YES-4 of Devices: l(' SELECT SCOPE(REQUIRED): ata Intercom 0 Thermostat In Audio •pecure Access 0 Security System 0 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. 0 Other(List All): y� ��r+ w� Rtf/�w �, 1 t , t,o--. CODE COMiR..L4NC .^ ..- , :,a.7'i raz 1 -5:...; . a 2. -. ? _ - - � ■ YES—See Below&Pg.2 IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 0 By checking this box,I am stating that I have read and understand all of1NAC 296-46B-98 i,se ected 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: NO OYES-See Below&Pg.3 0 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on b il gs 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 _c_ EF li is�* _ ._ .. t .., ._ . - - � y., a ..! . . _......f�li�r�a��'��o�AiA��w_ � i � fk OWNER NAME:, %U�C Y•�r TENANT BUSINESS NAME(It Commercial): OWNER MAiLING ADDRESS: smear r?A 05 ' C.1 Li ,- ' �`t"� + .t cnY G l) V'� yf- ' 1 STATE J [ 1 +. uP e- .)., OWNER PHONE: OWNER EMAIL: . . ....., <... ._. . • CONTRACTOR NAME: LA41 C•I? & e-, c' , CONTRACTOR ADDRESS: STREET 4! 3 S ,..4_ = /.` -- ei r F (�QJ tp I —T li4 ti�) -. STATE 0 r z� 1. '`- 2 . CONTRACTOR EMAIL: i 3 J Acit> 141 ,7(C e e- . io Hi CONTRACTOR PHONE: �S z 3 'CITY OF EVERETT BUSINESS LIC.�t(REQUIRED): ��! if CONTRACTOR LIC.4(RECUiRED) Ill 4SGG Q�- ,{ 7 .....LI C. ._ .. __.._ .;_ PRIMARY CONTACT: ❑OWNER i`kONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: `J �� CONTACT PHONE: 50 e'i 42s �+ 3 `c q (,,-, �t . F7G iJ�`c.-F� CONTACT EMAiL' � • A LL� to 1�'L' AGREEMENT:i he • :rill)/that I have read and examined this application end know the same to be tare and correct. Alf provisions of taws and ordinances governing this type of work wi •-comptet-• whatharspacrfed 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 local law reg -ring construct!.n or re performance of construction. That tam authorized by the owner of this properly to perform the wcttork r hret ich applic Otte ialaion Use On Ls ye and I comply v,7I Ire Stare Contra. . ,'aw 18.27 RCN and 29e.200 WAC FERMIT#: • . — - —! c �' Date (Revised 1/11/2019) Page 1-Application Own r/Au • [zed tSlgnature