6930 CARSON RD 2024-02-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICE EVERETT 3204 CEDAR STREET,EVERETT.WA 982' WASRENGTON (P)425-257.8810 1(E)PermitServices@everetWm.gov I www.everettwa.govJperma& 77_7 77 PROJECT:Si.TE#IIEFORMATION PROJECT ADDRESS: CA 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*I ESCRIP,,T, ot-W Rif CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: , ell THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO 'LKYES-Select Scope:x Service ❑Feeder ❑Clrcuits±- ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO AYES-#of Devices:_ SELECT SCOPE(REQUIRED)._,91 Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An rradd��ditional Fire Alarm Permit is required for review of device location and installation approval. L_I Other{List All): `::GODE`C..OMPL-IANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: J NO „ YES See Below&Pg.2 ❑ By checking this box,I am stating that 1 have read and understand all of WAC 296-46"00,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 ES-See Below&Pg. Pursuant to RCW 19,28,261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease E] without the proper electrical licensing and certificaliion,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 S CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY /�f STATE Zip CONTRACTOR PHONE — CONTRACTOR EMAIL: C _ CONTRACTOR LIG,#(R UIIZED): a- CITY OF EVERETT BUSINES kLIC.#(REIQUIRED): PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please ecify) CONTACT NAME: A9/ CONTACT PHONE: CONTACT EMAIL: AGREEMENT,I hereby certify that J have read and examin t s application and know the same to ba true and correct AN pr "woos of laws and and nances governing this TYPO work will be completed whether specified ho bt. The granting of a permit does not presume to give authority to violate or cancel fhe provisions of any other state or local Jaw regull ating eonstfuclton arihe rmance of construction. That I am authorized by the owner of this property to perform the work for w1dah application Is made and t comply with the State Contract w 1&.27 RC W and 296.280 WAC. City of Everett Official Use Only PERMIT#: — IE Owner/Authorized Agent Signature Date (Revised 4157022) Page 1•Application