2026 RUCKER AVE 2024-11-08 - 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@evereftwa.gov I vNAY.everettwa.gov/permits -off-7 7 77 PROJECT ADDRESS: LA c- Ke-, IBUILDING AREA: PROJECT TYPE: ONEW CONSTRUCTION 13ADDITION 13 TENANT IMPROVMENT )5REMODEL BUILDING USE: 13 SFR OTOWNHOUSE ODUPLEX EIADU 9-9U-LTI-FAMILY-#OF UNITS: ❑ COMMERCIAL % ',.ION! WRIP-I AIC LAP . -1, Rjr.1 NF M T 1A.,P08 �-TIOR4WW CONTRACT PRICE OF WORK:$ 1ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (-Z (-o It u,e_ THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 1.40 ES-Select Scope: 11 Service ❑ Feeder 13 Clrcuits-#:� Zsomplete Re-wire LOW VOLTAGE WORK? � Data gNO ❑YES-#of Devices: SELECT SCOPE(REQUIR D): ❑ Intercom ❑Thermostat IJ❑Audio Secure Access 13 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): MPLAN R", IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES- ETNO LJ YES See Below&Pg.2 0 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: D NO O'�ES-See Below&Pg.3 El 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, C "1NF0RMATf0N_",;--"` OWNER NAME: TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: STREET/9V 4?V* i� 0 W CITY STATE l'Ar ZIP OWNER PHONE- � 7� '_�_-k n, ?=��C!�NER EMAIL: Dala CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: 1CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED)., ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: P-bWNER ❑CONTRACTOR 11 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ftILA_/� Miller - CONTACT EMAIL: AGREEMENT.I hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and brdiriancdegoverning 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 with the State Contractors Law 18.27 RCW and 296.200 WAG. [PERMIT— #: City of Everett Official Use Only Z4"' � I E -� Yo 0 - 136 Owner/Authorized Agent Signature Date (Revised 41512022) Page 1-Application