8411 E XAVIER WAY 2023-10-16 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION �g CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 whsttn000N (P)425-257-8810 I(E)PermitServices@everettwa.gov everettwa.gov I vmweverettwa.gov/permits, ... _ '` ., PINECT:.:SITE.INFORM, ,TIoN° ' ' �' f PROJECT ADDRESS:8411 E Xavier Way, Everett BUILDING AR A: 600 sq ft PROJECT TYPE: E NEW CONS 116116 ❑ADDITION a TENANT IMPROVMENT QRE \'e.- BUILDING USE: El SFR TO iHOUSE El ElADU El MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL :ELE T . L APPUCAT1ON,INF ORMATION 44,DESVAIRTION OF WORK '" l n/a-previo9s owner did CONTRACT PRICE OF WORK $ ASSOCIATED BUILDING PERMIT#(If applicable): + ,� the wr-,c)K.2e years ago � m.._..._ DESCRIBE SCOPE OF W RK --- Basement Exec rical work Basement Electrical work THIS INSTALLATION INCLU S HE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WO ? NO DYES-Select Scope:I Service E Feeder 0 Circuits-# El Complete Re-wire LOW VOLTAGE RK? cZrr '�NO El YES-#of Devices: A i_SELECT SCOPE REQUIRED): I Data L:Intercom ❑Thermostat ❑Audio 0 Secure Access d 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): ----- 1:I -� ,' & � - .,a p, sF � IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO U YES--See Below&Pg.2 LBy checking this box,I am stating that I have read and understand all of WAC 296.46E-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:ONO DYES-See Below&Pg. 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 a application to receive an exemption from this licensing/certification requirement. . -'a3``- ..tea r _ . ,ONT` .„ INFORMATIO. 1 01 ' .: 141,1 v. OWNER,NAME:KeVin Dong TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET7188 169TH AVE SE c„Y Bellevue STATE WA ZIP 98006 OWNER PHONE:425-598-8888 OWNER EMAIL:kedo1 O09@gmail.com CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC,#(REQUIRED) PRIMARY CONTACT: DOWNER ['CONTRACTOR [)✓ OTHER(Please Specify) Owner assistant CONTACT NAME: CONTACT PHONE:206-227-3768 ■ay Du CONTACT EMAIL:ray@evergrandholding.com AGREEMENT:!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 performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18,27 RCW and 298.200 WAC. City of Everett Official Use Only PERMIT#: i E Z2 Ow uthorized Agent Signature Date (Revised4/5✓2022) Pagel Application