4628 W VIEW DR 2023-08-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1(E) PermitSemices@evereltwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:4628 W View Dr BUILDING AREA: 2200 sq ft 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: $24K ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE .SCOPE OF WORK: INSTALL PHOTOVTAIC ROOF MOUNT SYSTEM UP DATE METER SERVICE PANEL AND MAST FROM 65 AMP TO 200 AMP INSTALL PHOTOVTAIC ROOF MOUNT SYSTEM UP DATE METER SERVICE PANEL AND MAST FROM 65 AMP TO 200 AMP INSTALL COMBINER PANAL 120/240 VAC 100A,2P 20A/2P PV BRACKERS INSTALL SQUARE D FUSE AC DISCONECT NEMA 3R 60A 120/220VAC W60A FUSE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? FIND ❑✓ YES -Select Scope: Z Service ❑✓ Feeder ❑ Circuits-#:1 ❑ Complete Re -wire LOW VOLTAGE WORK1 NO - of evices: �— SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access 11 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 LJ YES -- See Below & Pg. 2 By checking this box, I am staling that I have read and understand all of WAC 29646B-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 ✓❑YES -See Below & Pg. Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease 21 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:ARLON D OWENSBY TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: ITREET4628 W VIEW DR Cm EVERETT STATE WA Z1P98203 OWNER PHONE:4253152841 1OWNER EMAIL:TIMETRAVLER163@YAHOO.COM CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CRY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ®OWNER ❑CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: /�� O lJ S'/3 CONTACT PHONE: q, j 3 (� �. `'(III CONTACT EMAIL: AGREEMENT: thereby cenity that t have read anoxammed mis appucauon ana Know me same tone mm arm correct. .....Ii -- type of work will be completed whether specified herein or not. The granting are permit does not presume to give authority to violate or cancel the provisions of any other state orlocal law regulating constucton or the performance ofconstmctlon. That l am authorized by the owner ofthis property to perform the work for which application is made and comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: Owner/Authorized Agent Signature 67 e - (Revised 41512022) Page 1-Application