309 42ND ST SW 2023-06-27 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 wAs H I NGTOn (P) 425-257-8810 J FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: (3 ct 2 t � IBUILDINGAREA: - 5� 00 �--- sq ft PROJECT TYPE: ONEW CONSTRUCTION DADDITION OTENANT IMPROVN#ENT Z4 REMODEL BUILDING USE: EZSFR DTOWNHOUSE El DUPLEX ❑ ADU EIMULTI-FAMILY - # OF UNITS; D COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPT'IO N OF WORK CONTRACT PRICE OF WORK: $ rc?p -- ASSOCIATED BUILDING PERMIT # (if applicable). DESCRIBE SCOPE OF WORK: '� c u WC.s L THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE; SELECT ALL THAT HAT APPLY LINE VOLTAGE WORK? ❑ NO ❑ YES _ Select Scope: ❑ Service Feeder Circuits-#: -f - Com fete Re- were LOW VOLTAGE WORK? &A NO [71 YES- # of Devices; SELECT SCOPE (REQUIRED): Data ❑ Intercom aThermostatAu i ❑ d o ❑ Secure Access ❑ Security System ❑ Fire Alarm - Installations under this permit onlyinclude electrical ectrical 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 AMID/OR PERSONAL CARE FACILITIES: ONO F7 YES -- See Below & Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-4613-990 of this application (see next page), AND plan Review is NOT re aired b , selected the specific reason on page 2 See Page 2 require Plan Review. q ecause ! meet all of the following sub sections that do not ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 7N OYES -See Below & Pg. 3 Pursuant to RCW 19.28.261 , property owners and leaseholders cannot perform electric without the r p al work on buildings for rent sale r proper electrical licensing and certification, or exemption. By checking this box, l am statin t 9 > e lease See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification g at I have completed and p censing/certification requirement. CONTACT INFORMATION OWNER NAME: S — TENANT BUSINESS NAME {If Commercial : OWNER MAILING ADDRESS: STREET 772- 1 MA r L� n 7 CITY S,JeI16S STATE ZIP �7/47OWNER PHONE: 2-6 -- � -~-3 6 7 3 OWNER EMAIL: �% � �'� �.C� C� Hca CONTRACTOR NAME: 1o4 CONTRACTOR ADDRESS: STREET CITY IAJ.IA STATE ZIP CONTRACTOR PHONE: Aj 14 CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: 2, OWNER DCONTRACTORDOTHERP(Please Specify) CONTACT NAME; CONTACT PHONE: 73 0 36 4/3 �iutn wt�zz'_s — CONTACT EMAIL: AGREEMENT., / hereby certify that 1 have read and examined thisC: 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 local law regulating construction or the performance of construction. That l am authorized b the owner of t t° violate or cancel the provisions of any other state or comply with the State Contractors Law 18.27 RC and 296.200 WAC. Y his property to perform the work for which application is made and 1 IERMIT #: City of Everett Official Use Only ERI1/IIT #: