4710 GARDNER AVE 2022-11-17 - Laserfiche WebLink

ELECTRICAL PERMI T APP1CATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WA HiK,e:TON (P)425 257 8810 I FAX 425 257 8857 I(E)everetteps@everettwa.gov I mwd.everettwa.gov/perrnits 11 I .I I .'Lk _I <.�.x.,l�., 1 -I.d..'�..I.I.aa.'i:.t..d.r.t:,k•7,h 1 o.z>...:.I I t:I:.I:,.a.,.?.»,. ..!. i..t.le.<.� i..i.,t..,.7:._z,L .� .I. h ...e..,., ., PROJECT ADDRESS: 4710 Gardner Ave BUILDING AREA: 8 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT E REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI FAMILY #OF UNITS: ❑ COMMERCIAL ll� I i i _ CONTRACT PRICE OF WORK: $ 2800.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Like and kind replacement of low voltage gate operator THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope;❑Service ❑ Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO El 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): ri; 1�1 t }} 1 I i � ' t I ry I 1 f l.C.i. ` ' � L i I A , ::I,. .i.l Il cKU I I..it r '..,.1. L a. .I T.I. :tl..... T".. .. �::. ,.. ,..}._....., . .t'�,. n. tl; I.�. ...u.;;1.T. . , ,..,..,..1 I <.... ...� ,.. ...'1.1..I � I :I:I�.� � ,. `..T. :l..: -. .n I. .:u. 1 .t1 1` � ' t1�� I rl' � I I �:1 t ; �: ,s IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 151 NO U 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: 0 NO AYES-See Below&Pg. 3 riPursuant 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. OWNER NAME: Travis Jorgenson TENANT BUSINESS NAME If Commercial : OWNER MAILING ADDRESS: STREET 4710 Gardner Ave tin, Everett STATE WA zip 98203 OWNER PHONE: tJor ensen tea ue com 206-307-9531 OWNER EMAIL: � @ 9 CONTRACTOR NAME: Security Gate and Access, LLC CONTRACTOR ADDRESS: STREET 5402 184th St E, Ste C CITY Puyallup STATE WA zip 98375 CONTRACTOR PHONE:253-847-9362 CONTRACTOR EMAIL:Trudy@sgawa.com CONTRACTOR LIC.#(REQUIRED):SECURGA886KZ CITY OF EVERETT BUSINESS LIC #REQUIRED 055293 PRIMARY CONTACT: DOWNER CONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-847-9362 Trudy Wood CONTACT EMAIL:Trudy@sgawa.com AGREEMENT:I hereby certify that!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 PERMIT#: J2 'i E OwnerlAuthori gent Signature Date (Revised 1/11/2019) Page 1-Application