12604 18TH DR SE 2023-04-11 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 (E) PermitServices@everettwe.gov I www everettwa goviperni PROJECT SITE INFORMATION PROJECT ADDRESS:12604 1 Hth DR SE Everett WA 98208 IBUILDING AREA: 1700 sq it PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ® REMODEL BUILDING USE: ® SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: S ASSOCIATED BUILDING PERMIT # (if applicable) DESCRIBE SCOPE OF WORK: Install manual transfer switch and inlet box for generator THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑8 YES - Select Scope ❑ Service ❑ Feeder ❑ Circuits-# ❑ Complete Re -wire LOW VOLTAGE WORK? R) NU ❑ YES- # of Devices. SELECT SCOPE (REQUIRED) ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access El 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: DO NO LJ YES -- See Below 8 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: NO DOYES -See Below & Pg Pursuant 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 CONTACT INFORMATION OWNER NAME: Ronald Rock TENANT BUSINESS NAME (if Commercial): OWNER MAILING ADDRESS, 12604 18th DR SE Everett ITA-F WA ZIP 98208 OWNER PHONE: 4255-2255-6001 1OWNER EMAIL: ron-nancy@comcast.net CONTRACTOR NAME. CONTRACTOR ADDRESS: STREET CITY ;TA TF ;'IF' CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ®OWNER []CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 425-225-6001 CONTACT EMAIL: ron-nancy@comcast.net A (.7t<tttvttty r I r eby cerRty Chet I nave rma end examined this application and know the same to be true and correct All provisions of laws and ordinances governing this type of work wr# 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 bcal law regulating construction or the performance of construction. That; am authonzed by the owner of this property to perform the work for wAuch application is made and I compry with the State Contractors Law f8 27 RCW and 296 200 WAC City of Everett Official Use Only rE�# 02-0H-2023 Owner/Authorized Agent Signature Date (Revised 4,5M22) Page 1-Application