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� ECEUVE ELEV fRICAL PERMIT APPLICAT N CITY OF EVERETT PERMIT SERVICES NOV 0 6 2023 EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 0 WASHINGTON (P)425-257-8810 I(E)PermitServices@everetlwa.gov I wwwi.everetivra.gov/per A PROJECT SITE INFORMATION PROJECT ADDRESS: 31U A N—jecson lhvd. JFV feM WA qeZo1 BUILDING AREA: Z Z6 sq ft PROJECTTYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANTIMPROVMENT REMODEL BUILDING USE: XSFR []TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION Sr. DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 5'IC%; 7•00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK:9,doccife d Ier plut. Psdd 6eodel c6or L.revi-t kC) bA-ttlm wl omj ,have. 10 ktv kjA V% o%fer walker ower Avrtd outlets 40 wudr0ow l v"Ove t b45. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO MYES-Select Scope:❑Service ❑Feeder M Circuits-#: 45 [:]Complete Re-wire LOW VOLTAGE WORK? �NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: KNo YES--See Below&Pg.2 ❑ By checking this box, I am stating that I have read and understand all of WAC 29646B-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 ❑YES-See Below&Pg. ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buil ings 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: N V Vlef TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: sTREET lk) f �VCCSU1 � d Crry 5.4dr'e 1I- STATE WIN zip 01fS7.01 OWNER PHONEIZ•d "Z.SZ -g618 OWNER EMAIL: bhuebv a r w9 9 a�1•�'''� CONTRACTOR NAME: 1401 1MvW1 Atex 69w% LLC CONTRACTOR ADDRESS STREET � 63 �SISt Ave. N CITY D u VA 11 STATE WA ZIP 0180101 CONTRACTOR PHONE:QZ197-7.23- 15*$I CONTRACTOR EMAIL: Nand wtAY1/`11 GAv► oe voA 1 l• eu" CONTRACTOR LIC.#(REQUIRED): 14ANDYA(.8 NO?- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 66397. PRIMARY CONTACT: ❑OWNER HCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: H ZS -7,7,3 15'8 Alex 61vrr," CONTACT EMAIL: tmclvl Atex COtn tma.a- euwv AGREEMENT.,I hereby certify that 1 have read and examined this application and know the same to be true and correct. All pr visions 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/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 WAC. City of Everett Officlal Use Only PERMIT#: F ld-l(-Zv23 1 E Owner/Authorized Agent Signature Date (Revised 41512022) Page 1-Application