|
IL��TRICAL PERMIT APPLI�IATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)d25-257-8810 i FAX 425-257-885T I(E)everette verettwa.gav t www.everettwa.govrpermits
<br /> PROJECT SITE INFCM' 1ION
<br /> PROJECT ADDRESS: i l 00 i.5 ' ` , ;,''P>t':.t J\ t 710 l BUILDING AREA 14 500 sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION 4i, TENANT IMPROVMENT n REMODEL
<br /> BUILDING USE: ❑SFR El TOWNHOUSE 0 DUPLEX Q ADU El MULTI-FAMILY-#OF UNITS: .'t COMMERCIAL
<br /> ELECTRICAL APPLICATION INFORMATION 1 DESK m, N OF WoRK
<br /> CONTRACT PRICE OF WORK:$ 1 L 0 'ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> t
<br /> c
<br /> DESCRIBE SCOPE OF WORK: :4 Z) h
<br /> : , ..j e, r.:tct^.,,Q� co 4-01% - 0 ( 2.)) { -tz via
<br /> r.,,,,,. `2_.I` Acre-- ciee,r'S Al--. A1.._.060 ,>
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> UNE VOLTAGE WORK? M NO El YES-Select Scope:El Service El Feeder ❑Circuits-#: El Complete Re-wire
<br /> El t -
<br /> LOW VOLTAGE WORK? NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data 0 Intercom El Thermostat El Audio )Z1 Secure Access El Security System
<br /> ❑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 /> El Other(List All):
<br /> coole,gompLIANCE
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILmEs: El NO t ( 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 /> IN 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 UCENSURE: MNO OYES-See Below&Pg.3
<br /> E 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 ref:nrve an exemption from this licensing/certifncation requirement.
<br /> CONTACT INFORMATION
<br /> OWNER NAME: fie}v i } fl,0(a,,i it TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET n 6 0 (3 - % ,
<br /> CITY L �,,t eeA^of 1 STATE L)s.l A ZIP L,.C..J 4
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: CI tL Cow p c)v
<br /> CONTRACTOR ADDRESS: suthh.l 9p r)° .( I, ,,, " (
<br /> ' ".
<br /> CITY .,•'S,'. G)''s, STATE tii TIP 9? q L 1'JI
<br /> CONTRACTOR PHONE: "s `'iric''1.;,.-3,0/7 j _CONTRACTOR EMAIL: 't''A CAA,V„I`2 i,,r'.,..e W.C.,P ncV t?/r5 Ci
<br /> CONTRACTOR UC.If(REQU DI: ' �f 74 Cr—AA-l TTY OF EVERETT BUSINESS UC.#(REQUI 5(') .
<br /> PRIMARY CONTACT: DOWN .......OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: - 3
<br /> 1 @- Lek t CONTACT EMAIL: c'ic k,k1Y>rti€, ec � +;12
<br /> r'S t 1 y , co'`YL,
<br /> AGREEMENT.I hereby certify I have read and examined this eppec�n and know the same to be true and correct. Al prtweseons of laws and ordinances governing this
<br /> type of work wie be completed wfnettwr Shed herein or not. The granting pia permit does not presume to give authority to violate or conceit the provisions of any other state or
<br /> local law regulating construction or the performance of construction.n. That!am authorized by the owner of this property to perform the work for which application is made and!
<br /> comply with the State Contract I Law 18.27 RCW and 296.200 WAC. City of Ever eft Official Use Only
<br /> PERMIT#:
<br /> f - Z2_ - 1 E 9 o S ._ \Zicl
<br /> Ovrmer/Authorized Agent Signature Date (Revised 1/11/2019) Page I-Application
<br />
|