Laserfiche WebLink
MIN <br /> 161.111 ESCTRICAL PERMIT APPLISTION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: J Sl7 132_0) sr- s - C- BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT Cl REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ /QC, ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: T $-mot( .1(m l ..,-,} ,.� frig' 11 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO El YES-Select Scope: El Service ❑ Feeder El Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data El Intercom El Thermostat El Audio El Secure Access Cl Security System <br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> Cl Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO El YES-See Below&Pg.2 <br /> ❑ 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: O EYES-See Below&Pg.3 <br /> ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Li Y - .K joys f 1 TENANT BUSINESS NAME(If Commercial): 1 1 is 7"i <br /> OWNER MAILING ADDRESS: STREET /S//�j I <br /> !?� D i ST <br /> CITY (r{/�i STATE Ai A- ZIP 76i2.0 8 <br /> OWNER PHONE: 42r"-37 u —!olio OWNER EMAIL: L (ovr (aI/rtt;71,f am.CONTRACTOR NAME: S7c "'S �/ <br /> CONTRACTOR ADDRESS: STREET 9/ (.}`Loy /1 A, <br /> CITY nL 1 C1,4 STATE IAA"'7 ZIP 7 o 5' <br /> CONTRACTOR PHONE: 4L puc 2 CONTRACTOR EMAIL: _,�y5-9,,,c _,r/L,,.t &v'. . <br /> CONTRACTOR LIC.#(REQUIRED): 5 s- - 9: CITY OF�ERTTT BUSINESS LIC.#(REQUIRED): 5''?2.0 <br /> PRIMARY CONTACT: [DOWNER CONTRACTOR EOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: // ^7 -007 Z <br /> c34e5 2>'C_ CONTACT EMAIL: 1 , 'I et ,s400 ie'll . <br /> AGREEMENT::1 hereby certify t at/have read and examined this application and know the samo be r'and-correct. All prl visions of laws and ordinances governing this <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> ra— �Zz EZ. 1O - i3Z <br /> Owner/A zedA lure Date / (Revised 1/11/2019) Page 1-Application <br />