1223 LOMBARD AVE 2025-01-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WAS RINOTON (P)425-257.8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJ CT #� ;II+IFI,tIR lfllllh l"IQ�1 .. PROJECT ADDRESS: 1223 LOMBARD AVE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: u COMMERCIAL eI EcTRMCAL APPU Al ION'1NFO*MATION&D RIPTIQN ©F.WORK CONTRACT PRICE OF WORK:$ 700 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ALTERING 1 CIRCUIT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 0 YES-Select Scope:❑ Service ❑ Feeder J❑Circuits-#: 1 - ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data Cl Intercom ❑Thermostat ❑Audio ❑ 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): ;CO,DIk0061PLIANCI ,, -•( IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I_J 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: Cl NO EYES-See Below&Pg. 3 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. i'i':CON_TAXPOINPORMA111,14r7i OWNER NAME: MICHAEL GILHAM TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1223 LOMBARD AVE CITY EVERETT STATE WA ZIP 98201 OWNER PHONE: 415-370-8625 OWNER EMAIL: MGILHAM2@GMAIL.COM CONTRACTOR NAME: PARKER BROS ELECTRIC CONTRACTOR ADDRESS: STREET 13630 54TH DR NE CITY MARYSVILLE STATE WA zip 98271 CONTRACTOR PHONE: 425-239-6319 CONTRACTOR EMAIL: GARY@PARKERBROSELECTRIC.COM CONTRACTOR LIC.#(REQUIRED):PARKEBE845NT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):6319HM0918 PRIMARY CONTACT: DOWNER ['CONTRACTOR ❑✓OTHER(Please Specify) OFFICE ADMIN CONTACT NAME:NATAL I E CONTACT PHONE: 360-572-0108 Iv CONTACT EMAIL: admin@parkerbroselectric.com AGREEMENT:1 hereby certify that 1 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 lam 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 WAC. City of Everett Official Use Only PERMIT#: rr✓r' 4/22/2019 E ' v l OwnerlA thorized Age Signature Date (Revised 1/11/2019) Page 1-Application 1