4202 TERRACE DR 2022-10-07 - Laserfiche WebLink

ELECTRICAL P • ERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.govI www.everettwa.gov/permits PROJECT SITE INFORMATION�t /` PROJECT ADDRESS: 4�2 T-C4 {�4G ti L tV��"�[t BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT rPREMODEL c BUILDING USE: 1J SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION&DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ /3 k ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 47700 !/ (Ube Pl.//r K �R // {1VI J i /0 a VY)IG�DU I Ve- rii rwit 20 a ,12ac1MYa � lie fiQ� ci( 'Z it. 10 a C i vi m ?-, 20 ki r rk) �ii �+fi, 2 a W�Shn �rrGu� 7; (2 ) � Q Arldp i17 /73 tb/ lfVIYI Warm/ kia,l(c'ti& y. / KKpp- 31MWi-Oi. Dwi t6O THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) 0 /f k fi f])(`f-(4VPS LINE VOLTAGE WORK? ❑ NO 'YES-Select Scope:UService ❑ Feeder ircuits-#: 7 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ 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: 71 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 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 EYES-See Below&Pg.3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for reri:.,sale,or lease without the proper electrical licensing and certification,or exemption. By checking this box, i am stating that I hava:completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. /�, �n� �A��/�f �i� CONTA4T.INFORMATION OWNER NAME: L. v`Ki v y e�l��/,V 'vl.r TENANT BUSINESS NAME(If Commercial): _ OWNER MAILING ADDRESS: STREET 4f2O2 I' K �.L DY �J CITY /' STATE Wt1 zIa / C/��'TJ 2 B 3 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: in uLS-e / Cam CONTRACTOR ADDRESS: STREET /��3�f�OC` /^�]th �Y �E /� {^� _ (�y�� (/��y C r, /`/�'L✓V�l/I '-7S�TATE 1� V 7-� 7✓2✓TJ CONTRACTOR PHONE: 42S•,3Z0• q/C- CONTRACTOR EMAIL: 1�"riYll(SCEC G)f Y)a_4 /- C& Y�� CONTRACTOR LIC.#(REQUIRED):I�V OC/l�-S' 2_ c 7 �I CITY OF EVERETT BUSINESSC.#(REQUIRED): Q`Z�!// o g PRIMARY CONTACT: ❑OWNER ,ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: / CONTACT PHONE: L.�Z�G�j,.,�� . I L�q• �/[ CONTACT EMAIL: /li/E�O�Kxf 1 rs {tee, in Aif('- AGREEMENT..I hereby certify that I have read and examined this application and know the same to be true and correct. A p}L a6visions 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 provi;io:s 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 ap,:Iication is made and I comply with the e Contra rs Law 18.27 RCW and 296.200 WAC. City of Everett O='icial Use Only PERMIT#: e E \0( D.(6 - L. Owner/Authori d Agent Signature Date (Revised 1/11/2019) >'sge 1-Application