2008 GRAND AVE 302 2023-06-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: "100(90 V( �( P1 U M BUILDING AREA: sq ft PROJECT TYPE: LINEW CONSTRUCTION 17ADDITIe�t'LJ TENANT IMPROVMENT NI/REMODEL j BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU MULTI-FAMILY-#OF UNITS::ti A-{ ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 2000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: LI k Gut G{t/w ri foV 0 vni t Vao(T/V I(AP vT P/P ( GOW Da THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑,IGO DYES-Select Scope: ❑ Service ❑ Feeder nCircuits-#: 4 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ 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: ❑ NO ❑YES--See Below&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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: SNO EYES-See Below&Pg. 3 ❑ 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: MitdaV n" �MwAENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET -0000 6 of k/`e, G� CITY l� °+ ( y' STATE V \I ZIP IC6 OWNER PHONE: n� O� OWNER EMAIL: fl a...= CONTRACTOR NAME: In House Electrical Services, Inc. CONTRACTOR ADDRESS: STREET1530 117th DR SE coy Lake Stevens STATE WA Z,P 98258 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:iheperfillts@gnlall.COnl CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: ['OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 Kelsey CONTACT EMAIL:ihepermits@gmail.com 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 the pe •ma, e 'f construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply wi the State ontractors Law 8.2 CW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 1 -(1/ith E n2 D4 Owner/Authorized Agent Sign► Pure Date (Revised 1/11/2019) Page 1-Application