2802 HEWITT AVE 2023-06-26 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)426-267-8810 1 FAX 4255--255g`7(8857 1(E)eMvverettepsg@4 eveegrettwa.gov 1 www.everettWa-90v/Per1TIItS {�y` - BUILDING AREA: sy ft PROJECT ADDRESS: Z PROJECT TYPE: ®NEW CONSTRUCTION ®ADDITION ENANT IMPROVMENT ®REMODEL BUILDING USE: ®SFRp/qy®T/A►OgWNHOU�SyEy/�qq®DyyUPLEX 13 ADU g[3 MULTI-FAMILYyy-#OF UNITS ®COMMERCIAL L14i91e:'i CONTRACT PRICE OF WORK:$ ,Z� ASSOCIATED BUILDING PERMIT#(if applicable}: DESCRIBE SCOPE OF WORK: 11111II:X THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ®NO YES-Select Scope:®Service ®Feeder ®Circuits-#: ®Complete Re-wire LOW VOLTAGE WORK? ®NO ®YES-#of Devices: ®Security System D): SELECT SCOPE(REQUIRE D): 0 Data ®Intercom 13 Thermostat ®Audio '®Secure Access ®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) r - - - L- *r- r..` S - `s 5 Y�pys ' ,,.. •-s - [?.; -'mss c. =a'�'4.1.Y��'�-, "�'.., -.."`-.z"T �c`R'T, - --� IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND1OR PERSONAL CARE FACILITIES: NO YES--See Below&Pg.Z By checking this box,I am stating that I have read and understand all of WAC 296468-900,se ectad 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 Pian Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE��fi S-See Below&Pg.3 ® Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on t,sale,or lease without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and Sea Page 3 signed the AFFIDAVIT on page 3 of this applicat{iion to receive an exemption from this licensing/certification requirement z �Y '`�, �'--^ s. 3 � �"s, �I 007 a �L7�y .. � ., �'-u.=-'�`•'^.- OWNER NAME: TENANT BUSINESS NAME if Commercial): OWNER MAILING ADDRESS: STREET AA • � STATE yK• ZIP env OWNER PHONE: OWNER EMAIL: e L CONTRACTOR NAME: tj CONTRACTOR ADDRESS: STREET 4 21 •�• STATE ZIP Cfiv CONTRACTOR PHONE: I CONTRACTOR EMAIL: CONTRACTOR LIG.#(REQUIRED): mue. CITY OF EVERETT BUSINESS LIC.#{REQUIRED PRIMARY CONTACT: ❑OWNER ONTRACTOR 171 OTHER(Please Specify) CONTACT NAME CONTACT PHONE: :& CON TACT EMAIL: AGREEMENT f hereby certify that I have rBad and examined this application and know the e o be true and correct. All provisions of taws and ordinances goveminghe flits type of work will be completed whether s�mea herein consfrucfion.granting tam authorized by the owner of this property to perform the work for which appal a to me to give authority to violate orcanc th p visy ationnsofais many de andtI or local law reg 9 C of Everett official Use Ont comply wi he Stat ctors w 98.27 RCW and 296.200 WAC. Only- PERMIT#: fy OwneriAu ori Lure ate {Revised9/99/2019) Pagel-Application