10725 19TH AVE SE 2023-04-07 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION /,, ^-- CITY OF EVERETT PERMIT 4"; A 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10725 19th Avenue SE BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS:12 ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 450.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 125amp Overhead Temporary Service. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope: CI Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio El 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ❑YES—See Below&Pg.2 E. 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: ENO [1YES-See Below&Pg.3 EPursuant 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. CONTAC (FORMATION OWNER NAME: Edis Kulaga - SDA TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: S-R=_ET 1122 130th Street SE -#A err, Everett STATE WA ZIP 98208 OWNER PHONE:206-830-0126 OWNER EMAIL:SDAhomes@gmail.com CONTRACTOR NAME: Tughan Electric, Inc. CONTRACTOR ADDRESS: STREET1911 235th Court NE CITY Sammamish STATE WA z,P 98074 CONTRACTOR PHONE:425`868-8072 CONTRACTOR EMAIL:Larry@tughanelectric.com CONTRACTOR LIC.#(REQUIRED):TUGHAEI943BP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044481 PRIMARY CONTACT: [DOWNER ❑CONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:-as above- Edis Kulaga CONTACT EMAIL:-as above- AGREEMENT:I hereby certify that I 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 t ,7performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the St on rectors 18.27 RCW end 296.200 WAC. City of Everett Official Use Only PERMIT#: E \c(0 -3/28/19 t� Owner/Authorized Age Signature Date (Revised 1/11/2019) Page 1-Application