6622 HIGHLAND DR 2023-09-15 - 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@everettwa.gov I vnvw.everethva.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �� /�� ( "t'� BUILDING AREA: 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:$ 020 , as ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: /9<4// 411-IV- 9 ` ene— IS o Fo Ali ✓» uµ THIS INSTALLATION INCLUDES THE FOLLOYVING 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: SELECT SCOPE(REQUIRED): ❑Data [:]Intercom ❑Thermostat . F1 Audio ❑Secure Access In 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: Lj NO LJ YES--See Below&Pg.2 ❑ By checking this box, I am stating 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 YOUAy-OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO aES-See Below&Pg. �PPursuant 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: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 6a 2 ' 1 /76 / CITY Cvt'r �� STATE U ZIP IZ OWNER PHONE: 3 oft -y -J OWNER EMAIL: `1 CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ❑OWNER ❑CONTRACTOR []OTHER(Please PRIMARY CONTACT: Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.,/hereby certify that 1 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 wit/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 performance of construction. That I am authorized by the owner of this 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#: F 04AL", &Lg E 2 ? 5 - o �� Ow !Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application