1616 126TH ST SE 2025-01-29 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@evercuwa.gov wew.e'erottwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1616 126th st se BUILDING AREA:P(3° sq ft PROJECT TYPE: NEW CONSTRUCTION Cl ADDITION El TENANT IMPROVMENT D REMODEL BUILDING USE: SFR E TOWNHOUSE El DUPLEX Fr]ADU D MULTI-FAMILY-#OF UNITS1 E COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 2000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: installed service and sub panel for home owners project. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? D NO 7 YES-Select Scope: 7 Service 7 Feeder El Circuits-#: D Complete Re-wire LOW VOLTAGE WORK? 142 NO E YES-#of Devices. SELECT SCOPE(REQUIRED): D Data El Intercom El Thermostat El Audio El Secure Access D Security System D 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. D Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: R1 NO 7 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: :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 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensingicertification requirement. CONTACT INFORMATION OWNER NAME: marie meyers TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1616 126th st se CITY Everett sl wa 7,, 98208 OWNER PHONE:425-478-4681 OWNER EMAIL: CONTRACTOR NAME: Forrest electric Ilc CONTRACTOR ADDRESS: box 12524 cr, mill creek STATF W 71P 98082 CONTRACTOR PHONE:425-273-5329 CONTRACTOR EMAIL:forrestelectric65@yahoo.com CONTRACTOR LIC.kREQUIRED):forree1941dn CITY OF EVERETT BUSINESS LIC.#iREQUIRED):55048 PRIMARY CONTACT: IOWNER HCONTRACTOR LIOTHER(Please Specify) CONTACT NAME. CONTACT PHONE:425-478-4681 steve kreger CONTACT EMAIL: AGRfi'f-tvIENT l hereby certify that I 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 7 he granting ol 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 ny the owner of this property to perform the work for which application is made and I comply with the Stale Contractors Law 18.27 RCW and 2,96.200 WAC. City of Everett Official Use Only PERMIT#: E 16111.- 0 ), Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application