2420 38TH ST ROYELL MANUFACTURING 2025-05-14

OLT ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION '-• PROJECT ADDRESS: Q(\ 61`, - \-"kn, 04' . BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION Ei ADDITION 0 TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX 0 ADU ❑ MULTI-FAMILY-#OF UNITS: I COMMERCIAL ELECTRICAL APPLICATION:INF.ORMATION & DESCRIPTION OF WORK . CONTRACT PRICE OF WORK:$ - — ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ,i 0 a\cy r\I\ /- Y� 1 ciC\AkVvssj ( l 1 dQ,`n 'L�� THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO t.'ES-Select Scope:El Service 0 Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO WYES-#of Devices: (49 SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat ❑Audio ❑Secure Access 0 Security System Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire arm 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: a NO ❑YES--See Below&Pg.2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46B-9,+, =lected 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: I NO DYES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on b ildi gs 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: TENANT BUSINESS NAME(If Commercial) XV\c 04-kip(kW) OWNER MAILING ADDRESS: STREET ,2)(\l ^ X\C1k k\A 'Rq 1) • CITY-N 0 6 i STATE \'�k ZIP"k CD,' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �"`�l‘(1,z((� ( A /1J 1 k l (• i-$rs - " CONTRACTOR ADDRESS: STREET\� ) \. CITY STATE \; ^ ZIP \' CONTRACTOR EMAIL: 1�C L 1 Ac' Ou C 1O,C,,(C c3 A' lI U(l`�-Lbw' CONTRACTOR PHONE�� iya-- �_ �-C J �� CONTRACTOR LIC.#(REQUIRE \Ut-Qt—� T1r>27)9) � 'CITY OF EVERETT USINESS Lid.#(REQUIRED):CA,Nai� PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: !1.N1 U-1 ?) tkto r` c)i /1\,(kY�C. � i),,\ \�v\ ` CONTACT EMAIL: ) t((�UIe 41(,010, (6 cuy\l`i r AG EMENT:I hereby certify that 1 have lead and examined this application and know the same tAPe try(and correct. A provisions of laws and ordinances 99ooveming 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 tr for Ewhich appli t Opica i n is Use Only e and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. CiPERMIT#: -V\-, 'Z E -2rot:2_— k LA 9--- Owner/Aut orized ent SI atur ` Date (Revised 1/11/2019) Page 1-Application