10515 EVERGREEN WAY 2023-04-06 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION ,111" CITY OE EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT.WA writ (P)425-257-i tie FAX 425.2514%057 (E) t'ettiva.gov I wiwvaverellwa.uoidelifiniis ' T.‘ PROJECT ADDRESS; io5-)s- Ev ca_car-Ee wAY BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSMUCTION 0 ADDITION NEI TENANT IMPROVMENT CI REMODEL , BUILDING USE: CI SFR al•TOWNHOUSE 0 DUPLEX CI ADO 0 MULTI-FAMILY-#OF UNITS:, Ea COMMERCIAL jasik CONTRACT PRICE OF WORK:$ 1r..00 "-=- ASSOCIATED BUILDING PERMIT#(if applicatiks): DESCRIBE SCOPE OF WORK: )6.)*./Au- voLviliTivz-`2 faci, A LPr•-% Fv „SA4$ THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY LINE VOLTAGE WORK? 1:1 NO CI YES-Select Scope:CI Service CI Feeder CI Circuits ,-e: 0 Complete Rre LOW VOLTAGE WORK? CI NO 13 YES-#of Devices: Ce SELECT SCOPE(REQUIRE* CI Data 17.3 intercom CI Thermostat CI Audio CI Secure Access CI Security System 'SI Eire 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. r3 Other(List „ THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 10 NO U YES See Below&Pg 2 Ej By checking this box,I am stating that I have read and understand all of WAC 2ee-488440,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT requited because I meet ell of the following sub sections that do not See Page 2 require Plan Review. 6,6 ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSUREIONO UYES-See Below S Pg.3 Pursuant to RCW 10,28.261,property owners and leaseholders cannot perform electrical work on holdings for rent,sale,or lease L.1 without the proper electrical licensing end certification,or exemption By checlung 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 licensingicettficetion requirement *WNER NAME: TENANT BUSINESS NAMESif Commercial* plosNye,jriJtsES OWNER MAILING ADDRESS: STOUT 4%/424455/1/4) WA - crrr Evi,;af TT Stare Mat q.isz•42ty OWNER PHONE: [OWNER CONTRACTOR NAME; g 4 IA r CONTRACTOR ADDRESS: smear 'Po &or. 3,i I . citY c-ZTIDeJ ems zs! 902Z3 CONTRACTOR PHONE: si 7t14 )44 CONTRACTOiq EMAIL: a Ego Ft az •tors, ONTRACTOR UC MREQuiRED): SHP,famf eA42.14,3 lary OF EVERETT BUSINESS qc.gi(REOUIRED): , PRIMARY CONTACT; C OWNER---1;11 CONTRACTOR D OTHER(Please Specify' ) CONTACT NAME: CONTACT PHONE: 14-2*c elf II /II 9 5 2024)ssp,42 , CONTACT EMAIL; •••=e„da . &ski H r AGREATANT:I heroby antaty that I have read and morrierme 7apeecatien sod knowre SOW,lobe hue end coma Oprevielom ofews and tedieremes devemft this type of wit be completed whether saatilied herein tti her The grontlei9 et a pewee deed not presamo it, authority re wog*or awed the prattles/Nat soy oetotstavol tow few regotafing construction crfhepeMvmrec,of annstruclieh Thal am miffior-Ved ty the ewe re re this peeper*te perform The leakier which appOofdloo is made end I cotripi with The State Cantractere Lew 1827 ici,CW sem 2P6200 WAC, C15,01 Everett citadel Use Only PEWIT a: ) Z- I Authorized Agent Signature Data "Oki:Tied 1/1/MO Page,;I-Application