10633 HOLLY DR 2024-11-14 - Laserfiche WebLink

O • ELECTRICAL PERMIT APPLICATION 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.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 10633 Holly Drive Everett,WA 98204 BUILDING AREA:2600 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ✓❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1500 ASSOCIATED BUILDING PERMIT#(if applicable): N/A DESCRIBE SCOPE OF WORK: Electrical trim out and correction fixes. Heat Pump Unit Installation, Electric Furnace Install. Switches and outlets install. GFCI outlets Protection as per code required installation THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? 0 NO ❑✓ YES-Select Scope:❑Service 0 Feeder 0 Circuits-#:6 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom 0 Thermostat 0 Audio 0 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. ❑Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO ❑YES—See Below&Pg.2 ❑ 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:ENO EYES-See Below&Pg.3 nI I 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:ANDREY PEREDEREYEV TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10633 Holly Drive crrr EVERETT STATE WA vP 98204 OWNER PHONE:206-235-5862 OWNER EMAIL:andreyrOStOV@ymail.Com CONTRACTOR NAME: SERGEY KOZYUBENKO CONTRACTOR ADDRESS: sTREET1532 93rd PL SW Cd)1 '4(21'\ ' 1 1 CITY EVERETT STATE WA zip 98204 CONTRACTOR PHONE: CONTRACTOR EMAIL:EXTREMESERGE@GMAIL.COM CONTRACTOR LIC.#(REQUIRED):SKELEEL887J3 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):NOT YET AVAIL PRIMARY CONTACT: ['OWNER ✓❑CONTRACTOR [(OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: - 425-478 7217 SERGE CONTACT EMAIL:EXTREMESERGE@GMAIL.COM AGREEMENT: hereby certify that l 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 I am authorized by the owner of this property to perform the work for which application is made and I comply wit a State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only _ !PERMIT#: