1327 112TH ST SE DISCOVERY CHILD CARE 2025-01-14

EL CTRICAL PERMIT APPLItTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: (3Z7 11 Z114 Sc c ,� BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ /00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 'c,IS.fire 44' tnn tat THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: El Service El Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat El 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. n Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: O El YES--See Below&Pg.2 I J 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: l�'TNO EYES-See Below&Pg. 3 fl 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: k m friv41,1,, TENANT BUSINESS NAME(If Commercial): 0 �(r ✓ ( j _I J (ivN OWNER MAILING ADDRESS: STREET +J -7 CITY r'=V �--- STATE VIA- ZIP 482.P OWNER PHONE: �-)-2c—(G I —('i 71 )IC OWNER EMAIL: � 1,'tCt!c j L, i 3 A2 fl\.5 .f c►w1 J CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET /9/40L U y -g A CITY y' L• STATE „ ZIP 9y0?/, CONTRACTOR PHONE: Lj--15 —21?—f7C 7 Z. CONTRACTOR EMAIL: ��S 16 X'44.1 0 ek2 11 CONTRACTOR LIC.#(REQUIRED): s' £ 23 1?� _CITY OF EVE TT BUSINESS LIC.#(REQUIRED): -$ j PRIMARY CONTACT: [DOWNER CONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Je.0 _ CONTACT EMAIL: . 5 4_ 4) � �� .y,t AGREEMENT:I hereby certify that I ha e read and examined this application and know the sam�to be tru6 and confect. All provisions f 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 I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: �— r� —�— E22o1 ' Og Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application