11632 EVERGREEN WAY BUN AND OC RESTAURANT 2023-10-23

.... .„, ACTRICAL PERMIT APPLIATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION Cv4(res., PROJECT ADDRESS: 44()2 \j f,1 , WA 1 zc L-j- BUILDING AREA: ?76 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION laTENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: q COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ b50 ' c ' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: -HOG kju, A_Ci1.40.0 ;cC( 6ioncicjz -tr ,xi,;i-inc -7,i-cri ei r 1 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? R NO DYES-Select Scope: El Service ❑Feeder El Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? P NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom El Thermostat El 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. El Other(List All): Si((1- CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ONO LI 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: XI NO DYES-See Below&Pg. ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on .uil•ings 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: } hr t Lc_ TENANT BUSINESS NAME(If Commercial): 1�1,a'1 X (SIC OWNER MAILING ADDRESS: STREET W:)'),AZ ti 4(k C)4) CITY F 70 r t (� STATE WI ZIP gjoefF OWNER PHONE: �— ./(•if T+(1,2. - IOWNER EMAIL: h(t,+1,\,G (Y CC) 61 f7)c°u I . c'N1) <) CONTRACTOR NAME: h(.7,1 t,Ui1 '7.nce-r- CONTRACTOR ADDRESS: STREET ,-,2 S%j-. !j I 5.6 I'd A V 6(-- CITY j(;"fi-I-'4,(,,, STATE WA ZIP 1X�I CONTRACTOR PHONE: 2,5 +±C) (2 CONTRACTOR EMAIL: (Mr( eth ej r tr t -c CONTRACTOR LIC.#(REQUIRED):`��'G/VC`4M ��C;41 L"-') CITY OF EVERETT BUSINESS LIC.#(REQUI D): 3� PRIMARY CONTACT: DOWNER CONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2C'& 4-6 b — 3e)Cf Ci I Ll Lc CONTACT EMAIL: /,J j 4 i cl a LIe c9 VYI I Cern AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ail 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#: It f.>2 =r1/- z- E 22-oCo -- O� 3 w er/Autho Ized Agent Signature D to (Revised 4/5/2022) Page 1-Application / /.