2006 EVERETT AVE 2026-01-02 - Laserfiche WebLink

ELECTRICAL PERMIT APPLILATION E� EVERETT32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET.EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov� jq p PROJECT SITE INFORMATION PROJECT ADDRESS: .106 Reatt PNL IBUILDING AREA: (` ft PROJECT TYPE: ❑ NEW CONSTRUCTION —1 ADDITION ❑ TENANT IMPROVMENT [I REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ illb•0o ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: IN 10Mni Okti6i VVIO SC Y)S ` pm` n iFak Yi. t [t")(_rt4 DO rl 51 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? O ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO YES-#of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure ccess ElSecurity System ElFire Alarm-Installations under this permit only include electrical wiring r ugh-in of the system.An additional Fire Alarm Permit is required for review of device location and installation apl roval. ❑ Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO Lj 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 f /lowing sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: PNO EYES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on b ildings 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: S6\h1*6t Ayh1 SS TENANT BUSINESS NAME(If Commercial): S 1 OWNER MAILING ADDRESS: STREET,^r Qh 1 Cmr Y v 1 n C 1 5o STATE (-),I ZIP s o�91 OWNER PHONE: h P, OWNER EMAIL: Y' A CONTRACTOR NAME: Mc L v- S,150 CONTRACTOR ADDRESS: STREET 16 D D 1A �A 1 S - crry M7• VC M U-\ 1 STATE L^_ ZIP 1101 CONTRACTOR PHONE: SW LA24 • 1325 CONTRACTOR EMAIL: �DIA I f n b Q C n M • ( 601 CONTRACTOR LIC.#(REQUIRED): MG R S(, 932 L$ CITY OF EVERETT BUSINESS LIC.#( EQUIRED): PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAAMIE_ CONTACT PHO.NE_- (�j� a) C LA) - $VS_-(,0 CONTACT EMAIL:� (Y)�Oojd AGREEMENT:/hereby certify that I have read and examined this application and know the same-to-be true and correct. All,provisions. flaws 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 with the State Contractors Law 18.27 RCW and 29E200 WAC. City of Everett Official Use Only PERMIT#: z�-n 1 Z3 E Ownerl horized Agent Signature Date (Revised 111112019) Page 1-Application