4027 4TH ST SE 2025-07-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 wAIHINaTON (P)425.257-8810 1(E)PermilServlcos@overettwa.gov I mmeveretivia.gov/permits PiRAC�'�'_$1�'Ea1NF.ORtVtl1 'ION_ �g ri - - i PROJECT ADDRESS:4027 4th St SE BUILDING AREA: 20000 ., sq ft L PROJECTTYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANTIMPROVMENT []REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE [:]DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ✓R COMMERCIAL Q>itllll�!'T14N A_D�SQR__�P�IOT��O�IJI�I(>iRl�� CONTRACT PRICE OF WORK:$50000 1ASSOCIATED BUILDING PERMIT#(If applicable): DESCRIBE SCOPE OF WORK: Annual electrical blanket permit - Everett Water Pollution Control Facility Perform Reparis , general upgrades as needed, maintenance THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ✓❑YES-Select Scope:0 Service Q Feeder [D Circuits.#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of lice system.An additional Fire Alarm Permit Is required for review of device location and Installation approval. 0 Other(List All):Electrical maintenance,like and kind replacement , _�,- � ' _ a �: mi IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES.-See Below&Pg.2 By checking this box, I am slating 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 Tile 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 ✓ ES-See Below&Pg. 21 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. OWNER NAME;CIty Of Everett TENANT BUSINESS NAME(If Cornmerclal OWNER MAILING ADDRESS: sTREEr32OO Cedar St c,n Everett STATE WA x,a 98201 OWNER PHONE:425-257-8220 OWNER EMAIL:kchristiansen@everettwa.gov CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE xir CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.f/(REQUIRED): PRIMARY CONTACT: QOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:.425-309-0470 Ken Christiansen [CONTACT EMAIL:kchristiansen@everettwa.gov AGREEMENT:i hereby cortity that I have road and examined this application and know the some to be true and correct. All provisions of laws and ordinances governing this type of work»N be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or concel the provisions of any otherstate or local law regulating construction or the performance of construction, That I am authorized by the owner of this property to parform the work for which application Is made and 1 comply with the S e Contractors Law 18.27 RCW and 296.200 WAC. cityof Everett Official Use onl PERMIT M 3/14/2023 E 0 erAuthorized Agent Signature Date (Revised 41512022) Page 1-Application