11625 AIRPORT RD SONRISE CHRISTIAN CENTER 2022-12-30

E ECTRICAL PERMIT APPLISTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: it Us ti G) Y pc fk d BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION E TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ /I C e&t*e) /Ct'CI — ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: II VAC /JN(T 60N7-/24L S )- 7I /amdsw / 1- Co Sc N.SCt2 I' P,Clcf 50,4A- Prre-c-r1/� THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 121 NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO K YES-#of Devices: S 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 rapproval. Other(List All): CO isBNIOR. , SMO CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO El YES--See Below&Pg.2 (l 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 ' I 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. C7t ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: czNO DYES-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. CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: OLMI(Y\i1 C I-.IEC , -\CP L- "TV CONTRACTOR ADDRESS: STREET 2►`l 18 (n(c)T H i.v' w. 2-07 WAS /� CRY QU ( �L� , STATE �/V�'C ZIP 98O4 3 CONTRACTOR PHONE: if -b841 CONTRACTOR EMAIL: OI'lr\ O �/ 1�me,dmaY:1 cct,I • Co+vt. CONTRACTOR LIC.#(REQUIRED): 0 L'(MP MI `'1 m 0 I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 01 q 2(Q® PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: / CONTACT PHONE: 4../a 3't/4/ -y/ L/t� // �7 4.r , �6'd - CONTACT EMAIL: ' S-�s2,Lde �)L ✓��/� S` ?A lvlc�"C _ c:,,)nvl AGREEMENT:I hereby certify that 1 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 const ion 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 actors Law '7 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 7/ ''of &64-)e-- E PLZ5 4 - 005 Owaer/A on n ignatu Date (Revised 1/11/2019) Page 1-Application `